ASCO GU 2018: Incidence and Predictors of Mortality Following Major Urologic Cancer Surgery
The authors of this study utilized a population based cohort to test the hypothesis that the nature and number of perioperative complications impact the probability of mortality in major urologic surgery: radical prostatectomy (RP), radical nephrectomy (RN), or radical cystectomy (RC). The database utilized was the Premier Hospital Database. 90d complications were captured using ICD9 codes and were categorized according to the Agency for Healthcare Research and Quality Clinical Classification categories. Models were adjusted for patient, hospital, and surgery characteristics. When examining the predictive probability of mortality, they assessed it in 3 scenarios: no complication (in either the index stay or readmission), index complication (complication during the index or initial admission), or readmission complication (complication during the readmission).
From 2005-2013, there were 630,828 RP, 306,532 RN, and 57,533 RC patients. At 90 days, 14.2% of RP patients had a complication, 39% of RN patients and 68.3% of RC patients. Readmission rates at 90 days for RP were 1.9%, 5.9% for RN, and 19.9% for RC.
On multivariable analysis, the presence of a complication resulting in readmission compared to an index complication nearly doubled the predicted probability of mortality for RN and RC (RN 1.7% to 3.6%, and RC 3.9% to 6.8%), for RP: <0.5% for both. The number of complications during the index stay and on readmission compounded the impact on mortality. For RN and RC, 4 complication vs. 1 complication resulted in a nearly 3-fold increase in predicted probability of mortality.
The nature of complications varied by incidence. The three most common complications that resulted in the greatest increase in predicted probability of mortality across all three operations included pulmonary, cardiac, and renal complications.
While what is presented is intuitively understood, they demonstrate using population-level data (using a newer database) that the number and nature of complications after major urologic cancer surgery impact the predicted probability of perioperative mortality. However, it would have been more useful to help provide guidelines regarding changes that can be implemented.
Speaker: Matthew Mossanen
Co-Authors: Ross Krasnow, Dimitar V. Zlatev, Steven Lee Chang
Institution(s): Brigham and Women’s Hospital, Boston, MA; Georgetown University, Washington, DC; Massachusetts General Hospital/ Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA
Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA