Analysis of gender differences in early perioperative complications following radical cystectomy at a tertiary cancer center using a standardized reporting methodology

Abstract

Objectives Gender differences in perioperative complications following radical cystectomy (RC) are under-studied, but suggest a tendency for higher blood loss and/or transfusion in females. Variability in reporting methodologies may affect findings; therefore, we utilized a standardized reporting methodology to evaluate for gender differences in perioperative complications at a tertiary cancer center. Materials and methods A retrospective review of the Memorial Sloan-Kettering Cancer Center (MSKCC) RC database between 1995 and 2005 was performed. All complications within 90 days of surgery were recorded and classified using a 5-grade modification of the Clavien system. Results Of 1,142 study patients, 280 (25%) were female. Preoperatively, females were more likely to have multiple co-morbidities (39% vs. 27%, P < 0.001), a prior abdominal surgery (64% vs. 42%, P < 0.001), and to be slightly less obese than men. Females had longer operative times (mean 413 vs. 391 minutes; P = 0.005), higher blood loss (mean 1,322 cc vs. 1,151 cc, P = 0.002), and higher transfusion rates (>4 units red blood cells: 13% vs. 8%; P = 0.025). Although females were significantly more likely than males to experience a complication within 90 days of surgery (72% vs. 62%; P = 0.003); we did not find any important differences in the rate, grade, type, or timing of complications between genders. Additionally, females were less likely than males to receive a continent diversion (25% vs. 40%, P < 0.001) or a pelvic lymph node dissection (90% vs. 96%, P < 0.001). Conclusions Females in our cohort had significantly higher blood loss, more transfusions, and a higher rate of complications. Females were also less likely to undergo a node dissection or continent diversion, for reasons not totally attributable to patient or disease characteristics, implying patient or surgeon preference played a role.