Abstract
INTRODUCTION AND OBJECTIVES: The ‘rates’ of complications following radical cystectomy (RC) are well known, however, the data regarding ‘timing’ is lacking. We sought to assess the median time-to-event for 18 principal postoperative complications within 30days following surgical intervention. Further, the complications were stratified into pre-/post-discharge and the predictors were identified; lastly, the effect of time-to-complication on secondary outcomes was evaluated. METHODS: A retrospective case-control study utilizing the American College of Surgeons National Surgical Quality Improvement Program database (2005-2011); Patients undergoing RC were identified using CPT-codes. RESULTS: Overall, 1,118 patients underwent RC. The overall complication rate was 32.4% and the median LOS was 8 days. The majority of complications (94.4%), except for myocardial infarction, primarily occurred around week 2 post-surgery (fig. 1) at a median time of 10.4 days. With relation to discharge, almost equal number of the complications occurred pre-/post-discharge (49% vs. 51%) with infectious complications and DVT/PE tending to present post-discharge. In multivariable-analyses, increasing age (OR1⁄41.02, p<0.001), black race (OR1⁄41.67, p1⁄40.001), and creatinine 1.2mg/dl (p1⁄40.002) were significant predictors of pre-discharge complications, while, diabetes (OR1⁄41.40, p<0.001) and advanced cancer (OR1⁄41.35, p1⁄40.007) were significant predictors of post-discharge complications. BMI 30 and continent diversions both increased (p<0.01) the odds for both preand post-discharge complications. For a given complication, timing did not affect the odds for mortality or re-intervention (OR1⁄40.42, p1⁄40.115; OR1⁄41.51, p1⁄40.875, respectively). CONCLUSIONS: Vast majority of complications following RC occur during week 2 post-surgery and approximately 50% of the complications occur post-discharge; this highlights the need for rigorous observation and follow-up at both inpatient/outpatient levels during the early postoperative period to decrease the burden of these complications. Further, knowledge regarding the timing and risk-factors for complications may facilitate improved patient-physician communication, both at admission and discharge.
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