Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy

Abstract

Abbreviations & AcronymsObjectives: To examine postoperative complications in a contemporary series of patients after radical cystectomy using a standardized reporting system, and to identify readily available preoperative risk factors. Methods: Using the modified Clavien-Dindo classification, we assessed the 90-day postoperative clinical course of 535 bladder cancer patients who underwent radical cystectomy and urinary diversion (ileal conduit n = 349, ileal neobladder n = 186) between June 2003 and February 2012 at a single institution. All Martin criteria for standardized reporting of complications were met. Uni-and multivariable analyses for prediction of complications were carried out; covariates included body mass index, Charlson Comorbidity Index, age, sex, American Society of Anesthesiologists Score, neoadjuvant chemotherapy, prior abdominal or pelvic surgery, localized tumor and urinary diversion type. Results: The 90-day rates for overall (Clavien-Dindo classification I-V) and high-grade complications (Clavien-Dindo classification III-V), as well as mortality (Clavien-Dindo classification V), were 56.4, 18.7 and 3.9%, respectively. Infections (16.4%), bleeding (14.2%) and gastrointestinal complications (10.7%) were the most common adverse outcomes. Independent risk factors for overall complications were body mass index (odds ratio 1.08) and Charlson Comorbidity Index ≥3 (odds ratio 1.93). Risk factors for high-grade complications were Charlson Comorbidity Index ≥3 (odds ratio 1.86), American Society of Anesthesiologists Score ≥3 (odds ratio 1.92) and body mass index (odds ratio 1.07, all P < 0.03). Conclusions: Radical cystectomy is associated with significant morbidity; nevertheless, the majority of complications are minor. Charlson Comorbidity Index, American Society of Anesthesiologists Score and body mass index might help to identify patients at risk for high-grade complications after radical cystectomy.

Short-term perioperative outcomes of patients treated with radical cystectomy for bladder cancer included in the National Surgical Quality Improvement Program (NSQIP) database

“…First, we show that the risk of postoperative complications after RC for bladder cancer remains high in a contemporary cohort (up to 30%). This is consistent with complication rates reported in previous studies, 1,2,6,8,20 and corroborates the need for accurate identification of preoperative risk factors for potentially avoidable adverse events. Our results suggest that preoperative BMI represents a significant predictor of overall postoperative complications.…”

“…Our results suggest that preoperative BMI represents a significant predictor of overall postoperative complications. Previous studies have linked increased BMI to a substantially higher risk of wound infection and dehiscence, 2,20 while others have suggested that construction of either urinary diversions or orthotopic bladder substitu- Although we do not advocate that obesity should be considered a contraindication for surgery, these patients may do better in the care of an experienced urologist. Additionally, modifying surgical technique and using the appropriate surgical instruments are essential to minimizing the risk of adverse short-term outcomes in obese patients.…”

“…2,24 In the current study, the NSQIP database facilitated more accurate identification of the type of comorbidities, thus providing more clinically relevant information. For example, we were able to determine which specific comorbidities were associated with postoperative outcomes, instead of the overall comorbidity status as determined by a score relying on administrative data.…”

“…1 Despite refinements in surgical technique and perioperative management, RC has been associated with a substantial risk of postoperative morbidity and mortality, where the rates of short-term complications and mortality. [1][2][3][4][5][6][7] Identifying determinants of postoperative outcomes is crucial for individual risk-adjustment prior to RC. Several studies have reported predictors of complications, perioperative mortality, and readmission.…”

“…Several studies have reported predictors of complications, perioperative mortality, and readmission. However, these data are usually obtained from tertiary referral centres, 2,[5][6][7] and therefore may not be generalizable to the American population. Recent population-based studies have reported nationwide outcomes for patients treated with RC for bladder cancer.…”