Comparison of Major Complications at 30 and 90 Days Following Radical Cystectomy

Knorr, Jacob; Ericson, Kyle; Zhang, JJ H.; Murthy, P. Balakrishna; Nowacki, Amy S.; Muñoz-López, Carlos; Thomas, Lewis J.; Haber, Georges Pascal; Lee, Byron

doi:10.1016/j.urology.2020.08.038

Cited by 13 publications

(15 citation statements)

References 22 publications

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“…To our knowledge, this is the first study to evaluate this with a randomised design in patients undergoing RC. However, sev-eral observational studies have identified smoking as a predictor of complications following RC [21][22][23][24] and thereby indicated a potential effect of a smoking cessation intervention, but no previous studies have targeted smoking and risky alcohol intake in this patient group.…”

Section: Discussionmentioning

confidence: 99%

Effect of a Smoking and Alcohol Cessation Intervention Initiated Shortly Before Radical Cystectomy—the STOP-OP Study: A Randomised Clinical Trial

Lauridsen¹,

Thomsen²,

Jensen³

et al. 2022

European Urology Focus

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Section: Discussionmentioning

confidence: 99%

Effect of a Smoking and Alcohol Cessation Intervention Initiated Shortly Before Radical Cystectomy—the STOP-OP Study: A Randomised Clinical Trial

Lauridsen¹,

Thomsen²,

Jensen³

et al. 2022

European Urology Focus

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“…cystectomy, 66.3% of the 90-day adverse events were found to occur within the first 30 days, paralleling the findings of this study. 21 Those with postoperative adverse events in the 31 to 90 days (versus 0 to 30 postoperative days) were found to be more likely women (66.2% vs 61.7%, P , 0.001) and have a greater mean ECI (6.9 vs 6.5). Previous studies have found that female sex and comorbidities are associated with a higher overall rate of adverse events after PLF, but little is published regarding risk factors for earlier versus later adverse events.…”

Section: Discussionmentioning

confidence: 86%

“…However, in other surgical literature evaluating radical cystectomy, 66.3% of the 90-day adverse events were found to occur within the first 30 days, paralleling the findings of this study. 21…”

Section: Discussionmentioning

confidence: 99%

Adverse Events After Posterior Lumbar Fusion Are Not Sufficiently Characterized With 30-day Follow-up: A Database Study

Kammien

Zhu

Gillinov

et al. 2022

J Am Acad Orthop Surg

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Introduction: Many studies track outcomes after procedures, such as posterior lumbar fusion (PLF), for only 30 days because of database limitations. However, adverse events may not have plateaued by this time. Thus, this study used an alternate database to evaluate the timing of adverse events for 90 days after PLF.Methods: Adult PLF patients were identified from the 2010 to 2020 Q2 M53Ortho PearlDiver administrative data set. Ninety-day rates of multiple adverse events were determined. The time of diagnosis for each event in the 90-day postoperative period was determined. Data were dichotomized by occurrence in days 0 to 30 and 31 to 90. Median, interquartile range, and middle 80% for the time of diagnosis were determined for each adverse event.Results: Of 51,915 patients undergoing PLF, 7,141 (13.8%) had an adverse event within 90 days of PLF. Of these, 5,174 (72.5%) experienced an event within 30 days and 2,544 (35.6%) after 30 days. For individual adverse outcomes studied, the percent that occurred 31 to 90 days after surgery ranged from 9% to 42%. The time of diagnosis (median; interquartile range; middle 80%) for each adverse event was as follows: transfusion (2 days; 2 to 5 days; 1 to 26 days), acute kidney injury (9; 2 to 29; 1 to 60), hematoma (9; 4 to 20; 3 to 39), cardiac event (11; 3 to 43; 1 to 71), pneumonia (12; 4 to 38; 2 to 68), venous thromboembolism (15; 6 to 33; 3 to 62), sepsis (19; 9 to 39; 4 to 63), surgical site infection (21; 14 to 34; 8 to 48), urinary tract infection (22; 8 to 49; 4 to 72), and wound dehiscence (27; 17 to 39; 9 to 54).Discussion: This study highlights the importance of looking past the 30-day mark for adverse events after PLF because approximately onethird of adverse events in this study were diagnosed 31 to 90 days after surgery. This can affect research studies, patient counseling about the incidence of specific adverse events, and the development of mechanisms for surveillance at key time points.

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“…Unfortunately, our results found that those factors are underpowered to reveal any association with complications. Evidence that the risk of post-RARC complications is significantly higher in patients with DM, CKD, and dyslipidemia has been reviewed separately and individually in several literatures, [14][15][16][17][18][19][20] but our strength is considered to be the first to try to reveal an association in one study at once. Knorr et al 16 reported that chronic obstructive pulmonary disease (P = 0.030), CCI (P = 0.020), and Indiana pouch diversion (P = 0.002) were significant predictors of early complication.…”

Section: Discussionmentioning

confidence: 99%

Predicting factor analysis of postoperative complications after robot‐assisted radical cystectomy: Multicenter KORARC database study

et al. 2022

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Objectives To evaluate postoperative complications following robot‐assisted radical cystectomy in patients diagnosed with bladder cancer and reveal if there are predictors for postoperative complications. Methods Prospectively collected medical records of 730 robot‐assisted radical cystectomy patients between 2007/04 and 2019/05 in 13 tertiary referral centers were reviewed. Perioperative outcomes were compared between two groups by postoperative complications (complication vs non‐complication). We assessed recurrence‐free survival, cancer‐specific survival, and overall survival between groups. Regression analyses were implemented to identify factors associated with postoperative complications. Results Any total and high‐grade complication (Clavien–Dindo grade ≥3) rates were 57.8% and 21.1%, respectively. Patients in complication group had significantly higher proportion of diabetes mellitus (P = 0.048), chronic kidney disease (P = 0.011), dyslipidemia (P < 0.001), longer operation time (P = 0.001), more estimated blood loss (P = 0.001), and larger intraoperative fluid volume (P < 0.001). There was a significant difference in cancer‐specific survival (log‐rank P = 0.038, median cancer‐specific survival: both groups not reached). Dyslipidemia (odds ratio 2.59, P = 0.002) and intraoperative fluid volume (odds ratio 1.0002, P = 0.040) were significantly associated with high‐grade postoperative complications. Diabetes mellitus (odds ratio 1.97, P = 0.028), chronic kidney disease (odds ratio 1.89, P = 0.046), dyslipidemia (odds ratio 5.94, P = 0.007), and intraoperative fluid volume (odds ratio 1.0002, P = 0.009) were significantly associated with any postoperative complications. Conclusions Patients with diabetes mellitus, chronic kidney disease, dyslipidemia, or a relatively large intraoperatively infused fluid volume are more likely to develop postoperative complications. Patients with postoperative complications might have a possibility of lower cancer‐specific survival rate.

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Comparison of Major Complications at 30 and 90 Days Following Radical Cystectomy

Cited by 13 publications

References 22 publications

Effect of a Smoking and Alcohol Cessation Intervention Initiated Shortly Before Radical Cystectomy—the STOP-OP Study: A Randomised Clinical Trial

Effect of a Smoking and Alcohol Cessation Intervention Initiated Shortly Before Radical Cystectomy—the STOP-OP Study: A Randomised Clinical Trial

Adverse Events After Posterior Lumbar Fusion Are Not Sufficiently Characterized With 30-day Follow-up: A Database Study

Predicting factor analysis of postoperative complications after robot‐assisted radical cystectomy: Multicenter KORARC database study

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