Prophylactic Antibiotics and Postoperative Complications of Radical Cystectomy: A Population Based Analysis in the United States

Krasnow, Ross; Mossanen, Matthew; Koo, Sophia; Kubiak, David W.; Preston, Mark A.; Chung, Benjamin I.; Kibel, Adam S.

doi:10.1016/j.juro.2017.02.3340

Cited by 40 publications

(35 citation statements)

References 21 publications

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“…Perioperative prophylactic antibiotics mostly consisted of 24-h (n = 11, 44%) or single dose administration (n = 4, 16%). At the moment no clear recommendation on duration and exact type of antibiotic is given which leads to heterogenous regimes duration of prophylactic antibiotic therapy [49,50], therefore just a general recommendation to use prophylactic antibiotics can be given.…”

Section: Discussionmentioning

confidence: 99%

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

et al. 2020

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Purpose Different enhanced recovery after surgery (ERAS) protocols (EP) for radical cystectomy (RC) have been published. Protocols highly differ in number of included items and specific measures. Materials and methods A systematic review and meta-analysis on EPs in RC were performed using the databases MedLine, Cochrane Library, Web of science, and Google Scholar. The specific ERAS measures of the protocols were extracted, analyzed, and compared. Pooling of available outcome data was performed for length of stay, complications, readmission rate, and time to defecation. Results The search yielded a total of 860 studies of which 25 studies were included in qualitative and 22 in quantitative analysis. Oral bowel preparation (BP) was omitted in 24/25 (96%) EPs, optimized fluid management was administered in 22/25 (88%) EPs and early mobilization (postoperative day 1) in 21/25 (84%). Gum chewing (n = 12, 46%), metoclopramide (n = 11, 44%), and alvimopan (n = 6, 24%) were the most common measures to prevent postoperative ileus. Our meta-analysis revealed a significant benefit in favor of EPs for the outcome parameters length of stay [mean difference (MD) − 3.46 d, 95% confidence interval (CI) − 4.94 to − 1.98, p < 0.01], complications [Odds ratio (OR) = 0.76, 95% CI 0.61-0.94, p = 0.01] and time to defecation (MD − 1.37 d, 95% CI − 2.06 to − 0.69, p < 0.01). Readmission rate did not show a significant difference (OR = 0.73, 95% CI 0.52-1.03, p = 0.07). Conclusion Current EPs focus on omitting oral BP, early mobilization, and optimized fluid management while they differ in methods preventing postoperative ileus. Our meta-analysis revealed a benefit in introducing these protocols into clinical practice.

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Section: Discussionmentioning

confidence: 99%

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

et al. 2020

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“…In addition, infectious complications may also relate to the overuse of antimicrobial prophylaxis in urological surgery, variability in practice patterns among providers, and suboptimal compliance with clinical guidelines . In one study, 579 unique combinations of antimicrobial prophylaxis in RC were noted and as few as 15% received regimens based on guidelines . Improved antimicrobial stewardship in urological oncology and mindful use of antimicrobials in RC can also help mitigate infectious complications or decrease related adverse outcomes including Clostridium difficile colitis .…”

Section: Discussionmentioning

confidence: 99%

Associations of specific postoperative complications with costs after radical cystectomy

et al. 2017

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ObjectiveTo quantify the financial impact of complications after radical cystectomy (RC) and their associations with respective 90-day costs, as RC is a morbid surgery plagued by complications and the expenditure attributed to specific complications after RC is not well characterised. Patients and MethodsWe used the Premier Hospital Database (Premier Inc., Charlotte, NC, USA) to identify 9 137 RC patients (weighted population of 57 553) from 360 hospitals between 2003 and 2013. Complications were categorised according to Agency for Healthcare Research and Quality Clinical Classifications. Patients with and without complications were compared, and multivariable analysis was performed. ResultsAn index complication increased costs by $9 262 (95% confidence interval [CI] 8 300-10 223) and a readmission complication increased costs by $20 697 (95% CI 18 735-22 660). The four most costly index complications (descending order) were venous thromboembolism (VTE), infection, wound and soft tissue complications, and pulmonary complications (P < 0.001, vs no complication). A complication increased length of stay by 4 days (95% CI 3.6-4.3). One in five patients were readmitted in 90 days and the four costliest readmission complications (descending order) were pulmonary, bleeding, VTE, and gastrointestinal complications (P < 0.001, vs no complication). Readmitted patients had multiple complications upon readmission (median of 3, interquartile range 2-4). On multivariable analysis, more comorbidities, longer surgery (>6 h), transfusions of >3 units, and teaching hospitals were associated with higher costs (P < 0.05), whilst high-volume surgeons and shorter surgeries (<4 h) were associated with lower costs (P < 0.05). ConclusionsComplications after RC increase index and readmission costs for hospitals, and can be categorised based on magnitude. Future initiatives in RC may also consider costs of complications when establishing quality improvement priorities for patients, providers, or policymakers.

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“…Prophylactic antibiotic therapy has been shown to reduce short‐term urinary tract infection rates and duration of stay after radical cystectomy in man . Antibiotic usage inevitably leads to development of resistant populations and, perhaps unsurprisingly, higher rates of Clostridioides difficile infection when seen in humans managed with extended antibiotic prophylaxis after urological surgery .…”

Section: Discussionmentioning

confidence: 99%

Interventions and experience after complicated total cystectomy in a dog with transitional cell carcinoma

2019

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Objective: To report surgical and postoperative management of complicated total cystectomy in a dog with transitional cell carcinoma (TCC). Study design: Case report. Animals: One male neutered Shetland sheepdog.Methods: The dog was presented after a 1-month history of stranguria, unresponsive to oral antibiotic therapy. A craniodorsal bladder mass was identified by computed tomography (CT), and partial cystectomy was performed with 1-cm gross lateral margins (day 1). Results of histopathology provided evidence for a diagnosis of TCC, and the dog was treated with adjuvant mitoxantrone. The dog presented with uroperitoneum on day 67 after recurrence and spontaneous perforation. Total cystectomy and ureterourethral anastomosis were performed. Ureteral obstruction developed after removal of catheters that had been placed intraoperatively. Surgical revision included resection of the anastomosis site, bilateral ureteral stenting, and transection and reorientation of the distal urethra to facilitate tension-free closure. Postoperative leakage was managed with bilateral percutaneous nephrostomy tube placement. Results: The dog was discharged on day 88. Adjuvant treatment with vinblastine was pursued. Local recurrence was noted at day 154. Subcutaneous ureteral bypass was performed on day 247 to manage repeat obstruction. Repeated urinary tract infections were subsequently encountered. The dog was euthanized on day 368 because of abdominal discomfort and inappetence, with evidence of progressive urethral, ureteric, and abdominal wall TCC. Conclusion: Complicated cystectomy can be managed to provide survival comparable to previous reports regarding total cystectomy. Clinical significance: Nephrostomy tube placement, ureteral stenting, and subcutaneous ureteral bypass may be considered to manage complicated cystectomy.Preemptive stenting or urinary diversion may help prevent complications.

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Prophylactic Antibiotics and Postoperative Complications of Radical Cystectomy: A Population Based Analysis in the United States

Cited by 40 publications

References 21 publications

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Associations of specific postoperative complications with costs after radical cystectomy

Interventions and experience after complicated total cystectomy in a dog with transitional cell carcinoma

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