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An Evaluation of the Timing of Surgical Complications Following Radical Cystectomy: Data From the American College of Surgeons National Surgical Quality Improvement Program.

Abstract：

OBJECTIVE:To examine time-to-event data for 19 common postoperative complications within 30 days following radical cystectomy (RC). METHODS:Patients undergoing RC were identified within the American College of Surgeons National Surgical Quality Improvement Program database (2005-2011). The primary end point was time-to-complication; secondary end points included length of stay (LOS), reintervention, readmission, and 30-day mortality. Further, the complications were stratified into pre- and postdischarge, and the predictors were identified. Lastly, the effect of time-to-complication on secondary outcomes was evaluated. RESULTS:Overall, 1118 patients underwent RC. The overall complication rate was 52.1%; the median LOS was 8 days. The vast majority of complications (85.2%) were contained within the first 2 weeks of surgery with a median time-to-complication of 8.5 days; 31.4% of the complications occurred post discharge. In adjusted analyses, increasing age (odds ratio [OR] = 1.02, P < .001), black race (OR = 1.67, P = .001), and creatinine ≥1.2 mg/dL (OR = 1.26, P = .002) were significant predictors of predischarge complications, whereas diabetes (OR = 1.40, P < .001), cardiopulmonary disease (OR = 1.27, P = .005), neoadjuvant therapy (OR = 1.35, P = .007), and continent diversions (OR = 1.30, P = .004) were significant predictors of postdischarge complications. A body mass index of ≥30 was associated with increased odds of pre- as well as postdischarge complications (P < .01). For a given complication, timing did not affect the mortality odds (P = .310), but the risk of reintervention, readmission, and prolonged LOS varied. CONCLUSION:One in 2 patients suffers a complication within 30 days of undergoing RC. A vast majority of complications occur early on postoperatively, either pre- or post discharge, highlighting the need for rigorous inpatient as well as outpatient surveillance during this period-knowledge regarding the time-to-complications, the effect of time-to-complications, and risk factors may facilitate improved patient-physician communication and allow patient-tailored follow-up.

journal_name

Urology

journal_title

Urology

authors

Sood A,Kachroo N,Abdollah F,Sammon JD,Löppenberg B,Jindal T,Sun M,Trinh QD,Menon M,Peabody JO

doi

10.1016/j.urology.2017.01.036

subject

Has Abstract

pub_date

2017-05-01 00:00:00

pages

91-98

eissn

0090-4295

issn

1527-9995

pii

S0090-4295(17)30154-1

journal_volume

103

pub_type

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An Evaluation of the Timing of Surgical Complications Following Radical Cystectomy: Data From the American College of Surgeons National Surgical Quality Improvement Program.