An Evaluation of the Timing of Surgical Complications Following Radical Cystectomy: Data From the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP)

To examine time-to-event data for 19 common postoperative complications within 30 days following radical cystectomy (RC).

Patients undergoing RC were identified within the ACS-NSQIP database (2005-2011). The primary endpoint was time-to-complication; secondary endpoints included length-of-stay (LOS), re-intervention, readmission and 30-day mortality. Further, the complications were stratified into pre-/post-discharge and the predictors were identified. Lastly, the effect of time-to-complication on secondary outcomes was evaluated.

Overall, 1,118 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-complications of 8.5 days; 31.4% of the complications occurred post-discharge. In adjusted analyses, increasing age (OR=1.02, p<0.001), black race (OR=1.67, p=0.001) and creatinine ≥1.2 mg/dl (OR=1.26, p=0.002) were significant predictors of pre-discharge complications, while diabetes (OR=1.40, p<0.001), cardiopulmonary disease (OR=1.27, p=0.005), neoadjuvant therapy (OR=1.35, p=0.007) and continent diversions (OR=1.30, p=0.004) were significant predictors of post-discharge complications. BMI ≥30 was associated with increased odds of pre- as well as post-discharge complications (p<0.01). For a given complication, timing did not affect the mortality odds (p=0.310), but the risk of re-intervention, readmission and prolonged LOS varied.

One in two 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, their effect, and risk-factors may facilitate improved patient-physician communication and allow patient-tailored follow-up.

Urology. 2017 Feb 16 [Epub ahead of print]

Akshay Sood, Naveen Kachroo, Firas Abdollah, Jesse D Sammon, Björn Löppenberg, Tarun Jindal, Maxine Sun, Quoc-Dien Trinh, Mani Menon, James O Peabody

Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA; Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ., Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA., Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA; Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

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