Associations Among Age, Comorbidity and Clinical Outcomes After Radical Cystectomy: Results From the Alberta Urology Institute Radical Cystectomy Database

Abstract

We determined the associations among age, comorbidity and clinical outcomes after radical cystectomy. The study was a retrospective cohort analysis of 314 consecutive patients with primary bladder cancer treated with radical cystectomy between January 2000 and December 2006 in Edmonton, Canada. Comorbidity was obtained through a medical record review using the Adult Comorbidity Evaluation-27 instrument. The main clinical outcomes were 90-day mortality, early postoperative complications, and major and minor early postoperative complications. Logistic regression analyses were used to determine predictors of clinical outcomes. The 90-day mortality, any early postoperative complications, and major and minor early postoperative complications occurred in 18 (5.7%), 148 (47.1%), 78 (24.8%) and 92 (29.3%) patients, respectively. In univariate and multivariate logistic regression analysis age was not associated with 90-day mortality or early postoperative complications. In contrast, compared to patients with no or mild comorbidity, multivariate logistic regression analysis adjusted for age and surgeon procedure volume showed that severe comorbidity was associated with an increased risk of 90-day mortality (OR 6.4, p = 0.03). In addition, compared to patients with no or mild comorbidity, multivariate logistic regression analysis adjusted for age, sex, surgeon procedure volume, type of urinary tract reconstruction and American Joint Committee on Cancer stage showed that moderate and severe comorbidity were associated with any early postoperative complications (moderate OR 5.2, p <0.001; severe OR 7.0, p <0.001), major early postoperative complications (moderate OR 11.4, p <0.001; severe OR 15.2, p <0.001) and minor early postoperative complications (moderate OR 2.1, p = 0.019; severe OR 2.2, p = 0.038). Increasing comorbidity was independently associated with an increased risk of 90-day mortality and early postoperative complications after radical cystectomy.