Risk Factors Associated With Postoperative Complications Following Radical Cystectomy (A Retrospective Cohort Study)

Abstract

Background: Bladder cancer is the most often occurring cancer in the urinary system. At the time of diagnosis, one third of cases are already muscle invasive requiring radical cystectomy with or without chemotherapy and radiation therapy. Radical cystectomy is associated with high rates of postoperative complications. Objective: The aim of the study was to assess postoperative complications of radical cystectomy in Armenia and explore associated risk factors. Methods: The study utilized a retrospective cohort design. Study population included all patients who have undergone radical cystectomy followed by either continent or conduit urinary diversion from 2005 to 2012 in all hospitals of Armenia. Detailed medical chart review was conducted extracting information on baseline demographic and clinical characteristics, surgical intervention, postoperative management and in-hospital complications. Results: The total study sample included 273 patients with radical cystectomy. The mean age (sd) of the patients was 58.5(8.9) years and the majority (n=255, 93.4%) were men. Overall, 28.9% (n =79) of patients experienced at least one in-hospital complication. The hospital mortality rate was 4.8% (n =13). The most commonly reported complications were postoperative ileus (n = 20 or 7.3%), wound infection (n =19 or 7.0%), pyelonephritis (n = 13 or 4.8%), and wound dehiscence (n = 9 or 3.3%). Multiple logistic regression analysis revealed that coronary artery disease (OR=2.44, 95% CI: 1.20 – 4.96, p=0.01), receiving a transfusion (OR=2.40, 95% CI: 1.36 – 4.24, p<0.01) and hospital volume (OR=2.09, 95% CI: 1.03 – 4.24, p=0.04 for the second higher volume hospital compared to the highest volume) were the significant predictors of postoperative complications. Conclusions: The rate of postoperative complications following radical cystectomy in Armenia was similar to those observed in other countries. Hospital volume, presence of coronary artery disease and receiving transfusion were significant predictors of complications. Future prospective studies should evaluate the long-term outcomes, costs of the complications as well as the appropriateness of perioperative transfusion. Hospitals should standardize and improve the management of high risk patients. National health policy decisions makers should consider the evidence from this study with respect to observed association between hospital volume and risk of complications.