Risk factors and reasons for reoperation after radical cystectomy

Reese, Stephen W.; Ji, Emily; Paciotti, Marco; Leow, Jeffrey J.; Mahvi, David A.; Steele, Graeme S.; Urman, Richard D.; Whang, Edward E.; Kibel, Adam S.; Mossanen, Matthew

doi:10.1016/j.urolonc.2019.10.011

Cited by 17 publications

(19 citation statements)

References 48 publications

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“…It has been also associated with increased anastomotic leaks after intestinal operation, including ileocolic anastomosis, esophagectomy, liver transplantation, and gastrectomy (38)(39)(40)(41)(42). The association between hypertension and the development of surgical complications is unclear; however, decreased microvasculature and underlying atherosclerosis due to hypertension have been suggested as causes for increased surgical complications (27,32,37,39,40,42). Our study results suggest that antihypertensive drugs can also cause increase the risk of surgical complications in patients with hypertension.…”

Section: Discussionmentioning

confidence: 70%

“…Hypertension is a well-known risk factor for surgical complications in various surgeries, including breast reconstruction (31,32), joint replacement surgery (33)(34)(35), debulking cytoreductive surgery for ovarian cancer (36), and radical cystectomy (37). It has been also associated with increased anastomotic leaks after intestinal operation, including ileocolic anastomosis, esophagectomy, liver transplantation, and gastrectomy (38)(39)(40)(41)(42).…”

Section: Discussionmentioning

confidence: 99%

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Effects of antihypertensive drugs on surgical outcomes of breast reconstruction: a nationwide population-based claim study

Park

et al. 2021

Gland Surg

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Background: Experimental studies have reported that angiotensin receptor blockers (ARBs) increase the risk of surgical complications. However, clinical data on their effect on surgical outcomes are limited.The aim of this study was to investigate the impact of perioperative use of ARBs on the outcomes of breast reconstruction using population-based claim data.Methods: Data of patients who underwent direct-to-implant or abdomen-based autologous breast reconstruction after total mastectomy from April 2015 to December 2018 were obtained from the Health Insurance Review and Assessment Service database. The patients were categorized as ARB, non-ARB, control, and non-hypertension groups. The effects of ARBs on surgical complications, length of hospital stay, and complication-related medical costs were evaluated.Results: Of the 9,036 patients who met the inclusion criteria, 5,192 underwent direct-to-implant reconstruction, and 3,844 underwent abdomen-based autologous reconstruction. The length of hospital stay was the longest and the surgical complication rate and complication-related medical cost were the highest in the ARB group after both reconstruction methods. Compared with non-treatment with antihypertensive drugs, ARB use was found to be an independent risk factor for surgical complications in direct-to-implant reconstruction [odds ratio (OR), 1.96; 95% confidence interval (CI), 1.09-3.50; P=0.0237] and complicationrelated medical cost (OR, 1.93; 95% CI, 1.10-3.40; P=0.0221) in abdomen-based autologous reconstruction.Conclusions: Perioperative ARB use was associated with adverse postoperative breast reconstruction outcomes. These findings might have a significant impact on perioperative antihypertensive management; nevertheless, further studies are warranted to confirm the study findings.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Effects of antihypertensive drugs on surgical outcomes of breast reconstruction: a nationwide population-based claim study

Park

et al. 2021

Gland Surg

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“…To the best of our knowledge, efforts to promote smoking cessation in surgical oncology patients are scarce despite the fact that it may be one of the most modifiable risk factors for complications. The World Health Organization has named tobacco use as “the single most preventable cause of death in the world today.” 36 In a recent study by Reese et al, smoking was estimated to be one of the patient factors associated with an increased risk of reoperation after undergoing radical cystectomy for BC 2 . Despite the evidence demonstrating the impact of a cancer diagnosis on a patient's ability to stop smoking, the important role of the urologist in achieving this goal, 13 and the ethical basis for supporting cessation, 15 to our knowledge smoking cessation counseling is not offered routinely by physicians in general or prior to surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Smoking is the number one risk factor for bladder cancer (BC) worldwide and is estimated to directly account for approximately 50% of all BC cases, both male and female 1 . Smoking is detrimental to overall health, increases surgical complications, 2 raises health care costs, 3 and is associated with an increased risk of oncologic recurrence and mortality in patients with BC 4 . From a surgical morbidity perspective, tobacco smoking is a well‐known risk factor for more severe complications after major surgical procedures, such as wound infections and dehiscence, septic shock, pulmonary complications, and prolonged intensive care postoperatively 5 .…”

Section: Introductionmentioning

confidence: 99%

“…From a surgical morbidity perspective, tobacco smoking is a well‐known risk factor for more severe complications after major surgical procedures, such as wound infections and dehiscence, septic shock, pulmonary complications, and prolonged intensive care postoperatively 5 . Moreover, smokers may be more likely to require reoperation after radical cystectomy, which is the standard treatment for localized muscle‐invasive BC (MIBC) 2 . Within the context of contemporary awareness of the health risks of smoking, approximately 10% of patients with BC remain unaware of the link between smoking and BC 6,7 .…”

Section: Introductionmentioning

confidence: 99%

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The impact of smoking on radical cystectomy complications increases in elderly patients

Haeuser

Marchese

Schrag

et al. 2020

Cancer

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Background Smoking, the most common risk factor for bladder cancer (BC), is associated with increased complications after radical cystectomy (RC), poorer oncologic outcomes, and higher mortality. The authors hypothesized that the effect of smoking on the probability of major complications increases with increasing age among patients who undergo RC. Methods The authors analyzed the American College of Surgeons National Surgical Quality Improvement Program database (2011‐2017), identified all patients undergoing RC using Current Procedural Terminology codes, and formed two groups according to smoking status (active smoker and nonsmoker [included former and never‐smokers]). Patient characteristics and 30‐day postoperative complications using the Clavien‐Dindo Classification (CDC) were assessed. A multivariable logistic regression model was constructed that included age, sex, race, body mass index, operative time, comorbidities, chemotherapy status, and type of diversion with major complications (CDC ≥III) as the outcome variable, and explored the interaction between age and smoking status. Results A total of 10,528 patients underwent RC, including 22.8% who were active smokers. The authors identified an interaction between age and smoking status (P = .045). Older patients were found to experience a stronger smoking effect than younger patients with regard to the probability of major complications. The risk of a major complication was the same for 50‐year‐old nonsmokers and smokers, but it increased from 17.8% to 21.7% for 70‐year‐old nonsmokers and smokers, respectively (P < .001). Conclusions Up to 20% of patients who undergo RC are active smokers, and these individuals have an increased risk of major complications. The effect of smoking is stronger with increasing age; the difference with regard to complications for smokers versus nonsmokers was found to increase substantially, wherein older smokers are at an especially high risk of complications.

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The impact of preoperative nutritional status on post-surgical complication and mortality rates in patients undergoing radical cystectomy for bladder cancer: a systematic review of the literature

et al. 2020

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Risk factors and reasons for reoperation after radical cystectomy

Cited by 17 publications

References 48 publications

Effects of antihypertensive drugs on surgical outcomes of breast reconstruction: a nationwide population-based claim study

Effects of antihypertensive drugs on surgical outcomes of breast reconstruction: a nationwide population-based claim study

The impact of smoking on radical cystectomy complications increases in elderly patients

The impact of preoperative nutritional status on post-surgical complication and mortality rates in patients undergoing radical cystectomy for bladder cancer: a systematic review of the literature

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