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Temporal trends in perioperative morbidity for radical cystectomy using the National Surgical Quality Improvement Program database. Urol Oncol 2017 11;35(11):659.e13-659.e19

Date

08/06/2017

Pubmed ID

28778584

DOI

10.1016/j.urolonc.2017.07.013

Abstract

INTRODUCTION: Radical cystectomy (RC) is the standard of care for invasive nonmetastatic bladder cancer. Unfortunately, it is a complex procedure and more than half of patients experience a complication. A number of efforts to reduce perioperative morbidity have been made, including alterations in pain management, antibiotics, diet advancement, and anticoagulation. Many of these changes in management have been studied with favorable results; however, it is not clear whether complication rates following RC have improved in recent years. With this in mind we sought to evaluate current temporal trends in postoperative complication rates following RC using a large national dataset.

MATERIALS AND METHODS: Using the National Surgical Quality Improvement Program participant use files from 2010 to 2015, we identified patients undergoing RC using current procedural terminology codes. Demographic information as well as 30-day complications, length of stay (LOS), readmission and death were compared according to year of operation using univariable and multivariable analysis.

RESULTS: Over the 6 year period analyzed, 6,510 patients were identified for analysis. Age and comorbidity were similar across the study period. A robotic approach was used in 5.8% of the entire cohort which did not differ among years. A total of 15.9% of patients underwent a continent urinary diversion, with a trend toward decreased use in recent years, 31.5% of patients experienced a complication and this did not differ significantly among years, and 40.7% of patients required a blood transfusion overall with a trend toward decreased use. LOS decreased over time from 10.6 days in 2010 to 9.2 days in 2015 (P<0.01) whereas readmissions increased slightly over the time period to 21.4% in 2015 (P<0.01).

CONCLUSIONS: RC remains a procedure associated with high morbidity. In the recent era of enhanced recovery protocols, complication rates have not changed significantly, however, there has been a consistent decline in LOS and use of blood transfusion.

Author List

Johnson SC, Smith ZL, Golan S, Rodriguez JF 3rd, Smith ND, Steinberg GD

Author

Scott C. Johnson MD Assistant Professor in the Urologic Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Comorbidity
Cystectomy
Databases, Factual
Female
Humans
Length of Stay
Male
Middle Aged
Morbidity
Postoperative Complications
Quality Improvement
United States
Urinary Bladder Neoplasms
jenkins-FCD Prod-387 b0ced2662056320369de4e5cd5f21c218c03feb3