Perioperative mortality for radical cystectomy in the modern Era: experience from a tertiary referral center.

Abstract

PURPOSE:

To evaluate the perioperative mortality and contributing variables among patients who underwent radical cystectomy (RC) for bladder cancer in recent decades, with comparison between modern (after 2010) and premodern (before 2010) eras.

MATERIALS AND METHODS:

Using our institutional review board-approved database, we reviewed the records of patients who underwent RC for primary urothelial bladder carcinoma with curative intent from January 2003 to December 2019. The primary and secondary outcomes were 90- and 30-day mortality. Univariate and multivariable logistic regression models were applied to assess the impact of perioperative variables on 90-day mortality.

RESULTS:

A total of 2047 patients with a mean±SD age of 69.6±10.6 years were included. The 30- and 90-day mortality rates were 1.3% and 4.9%, respectively, and consistent during the past two decades. Among 100 deaths within 90 days, 18 occurred during index hospitalization. Infectious, pulmonary, and cardiac complications were the leading mortality causes. Multivariable analysis showed that age (Odds Ratio: OR 1.05), Charlson comorbidity index ≥ 2 (OR 1.82), blood transfusion (OR 1.95), and pathological node disease (OR 2.85) were independently associated with 90-day mortality. Nevertheless, the surgical approach and enhanced recovery protocols had no significant effect on 90-day mortality.

CONCLUSION:

The 90-day mortality for RC is approaching five percent, with infectious, pulmonary, and cardiac complications as the leading mortality causes. Older age, higher comorbidity, blood transfusion, and pathological lymph node involvement are independently associated with 90-day mortality.

• Authors: Sina Sobhani, Alireza Ghoreifi, Antoin Douglawi, Hamed Ahmadi, Gus Miranda, Jie Cai, Monish Aron, Anne Schuckman, Mihir Desai, Inderbir Gill, Siamak Daneshmand, Hooman Djaladat
• Journal: International braz j urol : official journal of the Brazilian Society of Urology (Int Braz J Urol) 2023 May-Jun Vol. 49 Issue 3 Pg. 351-358 ISSN: 1677-6119 [Electronic] Brazil
• PMID: 37115179 (Publication Type: Journal Article)
• Copyright: Copyright® by the International Brazilian Journal of Urology.

Topics

• Humans
• Middle Aged
• Aged
• Aged, 80 and over
• Cystectomy (methods)
• Urinary Bladder (pathology)
• Tertiary Care Centers
• Urinary Bladder Neoplasms (pathology)
• Carcinoma, Transitional Cell (pathology)
• Retrospective Studies