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TEMPORAL TRENDS IN PERIOPERATIVE MORBIDITY FOR RADICAL CYSTECTOMY

Login to Access Video or Poster Abstract: MP10-02
Sources of Funding: none

Introduction

Radical cystectomy (RC) is the standard of care for invasive non-metastatic bladder cancer. Unfortunately, it is a complex procedure with more than half of patients experiencing a postoperative complication. A number of efforts to reduce perioperative morbidity have been made, including alterations in pain management, antibiotics, diet advancement, and anticoagulation. Many of these changes in management have been studied with favorable results; however, it is not clear whether complication rates following RC have improved in recent years. We sought to evaluate current temporal trends in postoperative complication rates following RC using a large national dataset.

Methods

Using the National Surgical Quality Improvement Program (NSQIP) participant use files from 2010-2014, we identified patients who underwent RC. Demographic information as well as 30-day complications, length of stay (LOS), readmissions, and death were compared according to year of operation using univariable and multivariable analyses.

Results

Over the 5-year study period, 5257 patients were identified for analysis. Age, race and comorbidity were similar across the study period. Overall, 58.0% of patients experienced a complication, which did not differ among years. A robotic approach was used in 6.1% of the entire cohort, and 16.7% of patients underwent a continent urinary diversion, both of which did not vary among years. There were no significant changes in any specific complication types over the study period. Transfusion rate varied among years with no discernible trend over the study period (range 39.9-44.9%). LOS decreased over time from 10.6 days in 2010 to 9.4 days in 2014 (p<0.01) while readmission rate increased over time from 20.1% in 2011 to 22.1% in 2014 (p<0.01). On multivariable analysis, there were no predictors of complications, readmissions, or death.

Conclusions

RC remains a procedure associated with high morbidity. While there were no improvements in complication rate, there is a slow decline in LOS, possibly at the expense of an increasing readmission rate. This is the first study to our knowledge to demonstrate an inverse relationship between trends in LOS and readmission after RC.

Funding

none

Authors
Zachary Smith
Scott Johnson
Vignesh Packiam
Joseph Rodriguez III
Norm Smith
Gary Steinberg
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