Morbidity and Days Alive and Out of Hospital Within 90 Days Following Radical Cystectomy for Bladder Cancer

• Main Authors: Sophia L. Maibom, Martin A. Røder, Alicia M. Poulsen, Peter O. Thind, Marie L. Salling, Lisbeth N. Salling, Henrik Kehlet, Klaus Brasso, Ulla N. Joensen
• Format: Article
• Language: English
• Published: Elsevier 2021-06-01
• Series: European Urology Open Science
• Subjects: Bladder cancer; Enhanced recovery after surgery; Morbidity; Mortality; Radical cystectomy; Recovery
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666168321000732

Background: Morbidity after radical cystectomy (RC) is usually quantified in terms of rates of complications, mortality, reoperations, and readmissions, and length of stay (LOS). The overall burden following RC within the first 90 d following RC may be better described using days alive and out of hospital (DAOH), which is a validated, patient-centred proxy for both morbidity and mortality. Objective: To report short-term morbidity, LOS, and DAOH within 90 d after RC and risk factors associated with these parameters. Design, setting and participants: The study included 729 patients undergoing RC for bladder cancer at a single academic centre from 2009 to 2019. Data were retrieved from national electronic medical charts. Outcome measurements and statistical analysis: Multivariate analysis was used to investigate variables associated with a major complication, LOS >7 d, and DAOH <80 d. Results and limitations: The 90-d complication rate was 80%, including major complications in 37% of cases. Median LOS was 7 d (interquartile range (IQR) 6–9) and median DAOH was 80 d (IQR 71–83) days. Body mass index and the Charlson comorbidity index (CCI) predicted major complications. CCI predicted LOS >7 d and DAOH <80 d. Conclusions: RC was associated with significant short-term morbidity and DAOH was a good marker for cumulative morbidity after RC. We propose that DAOH should be a standard supplement for reporting surgical outcomes following RC for bladder cancer, which may facilitate better comparison of outcomes across treating institutions. Patient summary: We studied complications after surgical removal of the bladder for bladder cancer. We assessed a novel patient-centred tool that more accurately describes the total burden of complications after surgery than traditional models. We found that patients with a high body mass index and coexisting chronic diseases had a higher risk of a complicated surgical course.