Hospitalization before surgery and subsequent risk of infective complications after radical cystectomy: A population-based analysis

The length of stay prior to surgery increases the risk of postoperative infections (PIs) in several surgical settings, such as cardiac, orthopedic, and general surgery. However, data for urological oncology procedures are limited. We examined PI rates after radical cystectomy (RC) according to the length of stay prior to RC (LOSPRC).

A total of 24,242 patients with bladder cancer treated with RC between 1998 and 2013 were abstracted from the National Inpatients Sample database. We evaluated changes over time in LOSPRC (0 vs. 1 vs. 2 days or more) and tested its effect on PI rates. Multivariable logistic regression analyses were adjusted for the year of surgery, sex, age, ethnicity, comorbidities, hospital location, teaching status, hospital surgical volume, and number of hospital beds.

Overall, 19,401 (80.0%), 3,990 (16.5%), and 851 (3.5%) individuals with LOSPRC of 0, 1. and 2 or more were identified. The proportion of LOSPRC 0 patients increased from 61.4% in 1998 to 91.0% in 2013 (P<0.001), whereas the opposite trend was observed for LOSPRC 1 and 2 or more. In multivariable logistic regression analyses predicting PIs, LOSPRC of 1 (odds ratio: 1.38; 95% CI: 1.25-1.53; P<0.001) and LOSPRC of 2 or more (odds ratio: 2.15; 95% CI: 1.81-2.55; P<0.001) achieved independent predictor status.

A delay in surgery as short as 1 day significantly increases the risk of PIs after RC. In consequence, same day of admission surgery policies should be further promoted to reduce the risk of PIs.

Urologic oncology. 2017 Jul 26 [Epub ahead of print]

Emanuele Zaffuto, Raisa Pompe, Helen Davis Bondarenko, Marco Moschini, Paolo Dell'Oglio, Giorgio Gandaglia, Nicola Fossati, Shahrokh F Shariat, Francesco Montorsi, Alberto Briganti, Pierre I Karakiewicz

Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Surgery, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. Electronic address: ., Department of Urology, Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany., Department of Surgery, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada., Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria.