Examining the relationship between complications and perioperative mortality following radical cystectomy: A population-based analysis. BJU international Mossanen, M., Krasnow, R. E., Zlatev, D. V., Tan, W. S., Preston, M. A., Trinh, Q., Kibel, A. S., Sonpavde, G., Schrag, D., Chung, B. I., Chang, S. L. 2018


OBJECTIVE: To examine the incidence of perioperative complications after RC and assess their impact on 90-day postoperative mortality during the index stay and upon readmission.MATERIAL AND METHODS: A total of 57,553 bladder cancer patients (unweighted cohort: 9,137 patients) treated with RC at 360 hospitals in the United States between 2005 to 2013 within the Premier Healthcare Database were used for analysis. Ninety-day perioperative mortality was the primary outcomes. 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 =4 complications compared to one complication during hospitalization following RC (index stay) (1.0% to 9.7%, p<0.001) and during readmission (2.0% to 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 hospitalization cardiac (OR=3.1, 95% CI 1.9-5.1), pulmonary (OR=4.8, 95% CI 2.8-8.4), and renal (OR=3.6, 95% CI 2-6.7) related 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. This article is protected by copyright. All rights reserved.

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