The impact of preoperative ASA and serum albumin on early complication and survival rate of patients undergoing radical cystectomy for bladder cancer.

Abstract

313 Background: American Society of Anesthesiologist (ASA) score is used to evaluate the physical status of patients before surgery. Serum albumin is also a known marker of nutritional status. We evaluated the impact of preoperative ASA score and serum albumin on early complication and survival of pts who underwent radical cystectomy for bladder cancer. Methods: 1,964 patients with bladder cancer underwent cystectomy between 1971 and 2008 at the USC. Preoperative serum albumin and ASA score were available in 1471 and 1140 patients respectively. Post cystectomy early complication was defined as any postoperative event leading to lengthening hospital stay or re-admission within 90 days of surgery. Recurrence free survival (RFS) and overall survival (OS) for these cohorts were reviewed. Results: The demographic data of pts based on their serum albumin and ASA score is presented in table 1. Median follow up was 12.4 years (0 - 36.6 yrs). Low serum albumin (<3.4 g/dL) and high ASA score (3 or 4) were associated with higher early complication rate (43% vs. 33%, p= 0.03 and 40% vs. 28%, p= 0.0001 respectively). In multivariable analysis, low serum albumin was an independent predictor of RFS (HR 1.35, 95% CI 1.00-1.81) and OS (HR 1.62, 95% CI 1.29-2.04). High ASA score was an independent predictor of OS (HR 1.45, 95% CI 1.13-1.85), but not RFS. Conclusions: Preoperative low serum albumin and high ASA score are independently predictive of post cystectomy decreased overall survival. Low serum albumin is also a risk factor for recurrence after cystectomy. These parameters potentially could be used in nomograms to predict postoperative prognosis in patients undergoing radical cystectomy. Demographic data in 1,471 and 1,140 patients who underwent cystectomy for bladder cancer based on preoperative serum albumin and ASA score, respectively. [Table: see text]