Correlation between organ-specific co-morbidities and complications in bladder cancer patients undergoing radical cystectomy

Elmussareh, Muhammad; Simonsen, Povl; Young, Matthew; Kingo, Pernille Skjold; Jakobsen, John; Jensen, Jørgen Bjerggaard

doi:10.1080/21681805.2018.1531921

Cited by 18 publications

(10 citation statements)

References 27 publications

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“…The baseline characteristics of our study population who underwent RC were consistent with current literature, which demonstrates that patients who are younger, have fewer comorbidities, and localized disease are more likely to undergo RC for management of their bladder cancer. [8][9][10][11][12][13][20][21][22][23][24][25] Our study also found that increased age, advanced clinical stage, increased comorbidity, and decreased hospital volume were significantly associated with increased mortality as indicated in Table 3. Interestingly, we identified a significantly decreased mortality among patients receiving neoadjuvant chemotherapy (NAC) prior to RC at both 30and 90-days after RC.…”

confidence: 55%

Factors predicting early mortality after radical cystectomy for urothelial carcinoma in a contemporary cohort of patients

Kim

Kokorovic

Sharma

et al. 2020

CUAJ

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Introduction: We aimed to identify preoperatively available patient variables associated with increased mortality within 30 and 90 days of radical cystectomy (RC) for localized urothelial carcinoma (UC), and to evaluate temporal trends in early mortality rates. Methods: We reviewed the National Cancer Database to identify patients who underwent RC for UC between 2006 and 2013. Preoperatively available patient-specific demographics and mortality rates at 30 and 90 days postoperatively were analyzed. Univariable and multivariable logistic regression analyses were performed to examine factors associated with 30- and 90-day mortality. Results: We identified 37 366 patients who underwent RC between 2006 and 2013. Overall mortality rates remained stable over time. From 2006–2013, 936 patients (2.5%) and 2554 patients (6.8%) died of any cause within 30 and 90 days post-RC, respectively. On multivariable analysis, increased age, higher clinical T and N stage, increased Charlson-Deyo comorbidity classification, African-American race, lower hospital volume, non-academic centers, lower patient income, and absence of insurance were each significantly associated with increased early mortality after RC (p<0.05). The protective effect of higher hospital volume was similar regardless of patient’s age, clinical stage, or comorbidity status. Conclusions: Our study identified patient-specific variables that are significantly associated with increased early mortality after RC. These findings can be used in counselling to identify ideal candidates for RC to decrease patient harm. Furthermore, early mortality rates after RC have remained stable over time, indicating that ongoing quality improvement is essential to improve outcomes.

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confidence: 55%

Factors predicting early mortality after radical cystectomy for urothelial carcinoma in a contemporary cohort of patients

Kim

Kokorovic

Sharma

et al. 2020

CUAJ

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“…RC is a complex procedure associated with a considerable risk of postoperative morbidity and mortality. The rate of complications ranges from 19 to 92 percent in different studies [5][6][7][8][9], and the wide variation is likely related to whether implementation of standardised reporting guidelines was applied or not [10]. Randomised studies have indicated similar complication rates in patients treated with and without 1 3 NAC, but have not been designed to assess postoperative complications in a standardised fashion, i.e.…”

Section: Introductionmentioning

confidence: 99%

No increased risk of short-term complications after radical cystectomy for muscle-invasive bladder cancer among patients treated with preoperative chemotherapy: a nation-wide register-based study

et al. 2019

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Purpose Preoperative chemotherapy is underused in conjunction with radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) due to concerns for complications and delay of surgery. Prospective data on short-term complications from population-based settings with frequent use of preoperative chemotherapy and standardised reporting of complications is lacking. Methods We identified 1,340 patients who underwent RC between 2011 and 2015 in Sweden due to MIBC according to the Swedish Cystectomy Register. These individuals were followed through linkages to several national registers. Propensity score adjusted logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for complications and death within 90 days of surgery, comparing patients receiving preoperative chemotherapy or not. Results Minimum two cycles of preoperative chemotherapy were given to 519 (39%) of the patients, who on average tended to be younger, have higher education, better physical status, and more advanced bladder cancer than patients not receiving chemotherapy. After adjusting for these and other parameters, there was no association between treatment with preoperative chemotherapy and short-term complications (OR 1.06 95% CI 0.82-1.39) or mortality (OR 0.75 95% CI 0.36-1.55). We observed a risk reduction for gastrointestinal complications among patients who received preoperative chemotherapy compared with those who did not (OR 0.49 95% CI 0.30-0.81). Conclusion This nationwide population-based observational study does not suggest that preoperative chemotherapy, in a setting with high utilisation of such treatment, is associated with an increased risk of short-term complications in MIBC patients treated with radical cystectomy.

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“…Several studies have shown that increasing BMI is linked to increased risks of WD and other wound complications. 11 , 27 Reduced vascularity of adipose tissues, suppressed lymphatic immunity, and reduced subcutaneous tissue oxygenation are among several factors that were reported to contribute to wound infection and dehiscence among obese patients. 28 …”

Section: Discussionmentioning

confidence: 99%

Risk factors for wound dehiscence following radical cystectomy: a prediction model

Nasrallah

Mansour

Heidar

et al. 2021

Therapeutic Advances in Urology

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Objectives: Radical cystectomy (RC) is a complex urologic procedure performed for the treatment of bladder cancer and causes significant morbidity. Wound dehiscence (WD) is a major complication associated with RC and is associated with multiple risk factors. The objectives of this study are to identify clinical risk factors for incidence of WD and develop a risk-prediction model to aid in patient risk-stratification and improvement of perioperative care. Materials and Methods: The American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database was used to derive the study cohort. A univariate analysis provided nine variables eligible for multivariate model entry. A stepwise logistic regression analysis was conducted and refined considering clinical relevance of the variables, and then bootstrapped with 1000 samples, resulting in a five-factor model. Model performance and calibration were assessed by a receiver operated curve (ROC) analysis and the Hosmer–Lemeshow test for goodness of fit, respectively. Results: A cohort of 11,703 patients was identified from years 2005 to 2017, with 342 (2.8%) incidences of WD within 30 days of operation. The final five-factor model included male gender [odds ratio (OR) = 2.5, p < 0.001], surgical site infection (OR = 6.3, p < 0.001), smoking (OR = 1.8, p < 0.001), chronic obstructive pulmonary disease (COPD) (OR = 1.9, p < 0.001), and weight class; morbidly obese patients had triple the odds of WD (OR = 2.9, p < 0.001). The ROC analysis provided a C-statistic of 0.76 and calibration R2 was 0.99. Conclusion: The study yields a statistically robust and clinically beneficial five-factor model for estimation of WD incidence risk following RC, with good performance and excellent calibration. These factors may assist in identifying high-risk patients, providing preoperative counseling and thus leading to improvement in perioperative care.

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Correlation between organ-specific co-morbidities and complications in bladder cancer patients undergoing radical cystectomy

Cited by 18 publications

References 27 publications

Factors predicting early mortality after radical cystectomy for urothelial carcinoma in a contemporary cohort of patients

Factors predicting early mortality after radical cystectomy for urothelial carcinoma in a contemporary cohort of patients

No increased risk of short-term complications after radical cystectomy for muscle-invasive bladder cancer among patients treated with preoperative chemotherapy: a nation-wide register-based study

Risk factors for wound dehiscence following radical cystectomy: a prediction model

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