Examining the relationship between complications and perioperative mortality following radical cystectomy: a population-based analysis

BJU Int. 2019 Jul;124(1):40-46. doi: 10.1111/bju.14636. Epub 2019 Apr 14.

Abstract

Objective: To examine the incidence of perioperative complications after radical cystectomy (RC) and assess their impact on 90-day postoperative mortality during the index stay and upon readmission.

Patients and methods: A total of 57 553 patients with bladder cancer (unweighted cohort: 9137 patients) treated with RC, at 360 hospitals in the USA between 2005 and 2013 within the Premier Healthcare Database, were used for analysis. The 90-day perioperative mortality was the primary outcome. Multivariable regression was used to predict the probability of mortality; models were adjusted for patient, hospital, and surgical characteristics.

Results: An increase in the number of complications resulted in an increasing predicted probability of mortality, with a precipitous increase if patients had four or more complications compared to one complication during hospitalisation following RC (index stay; 1.0-9.7%, P < 0.001) and during readmission (2.0-13.1%, P < 0.001). A readmission complication nearly doubled the predicted probability of postoperative mortality as compared to an initial complication (3.9% vs 7.4%, P < 0.001). During the initial hospitalisation cardiac- (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.9-5.1), pulmonary- (OR 4.8, 95% CI 2.8-8.4), and renal-related (OR 3.6, 95% CI 2-6.7) complications had the most significant impact on the odds of mortality across categories examined.

Conclusions: The number and nature of complications have a distinct impact on mortality after RC. As complications increase there is an associated increase in perioperative mortality.

Keywords: #BladderCancer; #blcsm; complications; cystectomy; mortality; readmissions.

MeSH terms

  • Aged
  • Cystectomy / adverse effects*
  • Databases, Factual
  • Female
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Operative Time
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Urinary Bladder Neoplasms / mortality*
  • Urinary Bladder Neoplasms / surgery*