PD12-09 CHARACTERIZATION OF INFECTION RISK AFTER RADICAL CYSTECTOMY: RESULTS FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I1 Apr 2016PD12-09 CHARACTERIZATION OF INFECTION RISK AFTER RADICAL CYSTECTOMY: RESULTS FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM William Parker, Matthew Tollefson, Courtney Heins, Kristine Hanson, Elizabeth Habermann, Harras Zaid, Igor Frank, R. Houston Thompson, and Stephen Boorjian William ParkerWilliam Parker More articles by this author , Matthew TollefsonMatthew Tollefson More articles by this author , Courtney HeinsCourtney Heins More articles by this author , Kristine HansonKristine Hanson More articles by this author , Elizabeth HabermannElizabeth Habermann More articles by this author , Harras ZaidHarras Zaid More articles by this author , Igor FrankIgor Frank More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , and Stephen BoorjianStephen Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.904AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy (RC) represents the standard of care for muscle-invasive and high-risk non-muscle invasive bladder cancer. However, RC is associated with a high complication rate, including perioperative infection. In addition to causing patient morbidity, infections have been identified as a quality metric. Herein, we evaluated the incidence, risk factors, and timing of infection following RC. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify patients undergoing RC for bladder cancer from 2005-2013 using CPT procedure and ICD-9 diagnosis codes. Characteristics including age, gender, body-mass index (BMI), diabetes, smoking status, renal function, steroid usage, albumin, perioperative blood transfusion (PBT), and operative time were assessed for their independent association with the risk of infection (inclusive of urinary tract infection (UTI), surgical site infection (SSI), and sepsis) within 30 days of RC using multivariable logistic regression. RESULTS A total of 3,187 patients were identified, of whom 2,604 (81.8%) were male. Median age was 70 years (IQR 62, 77). Infection within 30 days of RC was diagnosed in 766 (24%) patients, at a median of 13 days (IQR 8, 19) after RC. The most common infections were SSI (404; 12.7%) and sepsis (405; 12.7%), followed by UTI (309; 9.7%). On multivariable analysis (Table), factors significantly associated with an increased risk of postoperative infection were BMI ≥ 30 (OR 1.52; p<0.01), receipt of a PBT (OR 1.28; p<0.01), and operative time ≥ 480 min (OR 1.69; p<0.01). When the outcomes of UTI, SSI, and sepsis were analyzed separately, operative time ≥ 480 min remained independently associated with increased infection risk in each model (OR 2.07 for UTI, OR 1.62 for SSI, and OR 1.74 for sepsis; all p<0.05), while PBT was associated with SSI and sepsis (OR 1.31 and OR 1.35, respectively; both p<0.05). CONCLUSIONS Approximately 25% of patients undergoing RC experience an infection within 30 days of surgery. Several potentially modifiable risk factors for infection were identified, specifically PBT and prolonged operative time, which represent potential targets for care improvement. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e296 Advertisement Copyright & Permissions© 2016MetricsAuthor Information William Parker More articles by this author Matthew Tollefson More articles by this author Courtney Heins More articles by this author Kristine Hanson More articles by this author Elizabeth Habermann More articles by this author Harras Zaid More articles by this author Igor Frank More articles by this author R. Houston Thompson More articles by this author Stephen Boorjian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...