Defining Early Morbidity of Radical Cystectomy for Patients with Bladder Cancer Using a Standardized Reporting Methodology

Abstract Background Reporting methodology is highly variable and nonstandardized, yet surgical outcomes are utilized in clinical trial design and evaluation of healthcare provider performance. Objective We sought to define the type, incidence, and severity of early postoperative morbidities followin...

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Bibliographic Details
Published in:European urology 2009-01, Vol.55 (1), p.164-176
Main Authors: Shabsigh, Ahmad, Korets, Ruslan, Vora, Kinjal C, Brooks, Christine M, Cronin, Angel M, Savage, Caroline, Raj, Ganesh, Bochner, Bernard H, Dalbagni, Guido, Herr, Harry W, Donat, S. Machele
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Cystectomy - adverse effects
Female
Humans
Incidence
Male
Middle Aged
Postoperative Complications - classification
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Retrospective Studies
Severity of Illness Index
Time Factors
Urinary Bladder Neoplasms - surgery
Urology
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Summary:Abstract Background Reporting methodology is highly variable and nonstandardized, yet surgical outcomes are utilized in clinical trial design and evaluation of healthcare provider performance. Objective We sought to define the type, incidence, and severity of early postoperative morbidities following radical cystectomy (RC) using a standardized reporting methodology. Design, setting, and participants Between 1995 and 2005, 1142 consecutive RCs were entered into a prospective complication database and retrospectively reviewed for accuracy. All patients underwent RC/urinary diversion by high-volume fellowship-trained urologic oncologists. Measurements All complications within 90 d of surgery were analyzed and graded according to the Memorial Sloan-Kettering Cancer Center complication grading system. Complications were defined and stratified into 11 specific categories. Univariate and multivariate regression models were used to define predictors of complications. Results and limitations Sixty-four percent (735/1142) of patients experienced a complication within 90 d of surgery. Among patients experiencing a complication, 67% experienced a complication during the operative hospital admission and 58% following discharge. Overall, the highest grade of complication was grade 0 in 36% ( n = 407), grade 1–2 in 51% ( n = 582), and grade 3–5 in 13% ( n = 153). Gastrointestinal complications were most common (29%), followed by infectious complications (25%) and wound-related complications (15%). The 30-d mortality rate was 1.5%. Conclusions Surgical morbidity following RC is significant and, when strict reporting guidelines are incorporated, higher than previously published. Accurate reporting of postoperative complications after RC is essential for counseling patients, combined modality treatment planning, clinical trial design, and assessment of surgical success.
ISSN:0302-2838
1873-7560
DOI:10.1016/j.eururo.2008.07.031