Mp65-19 an evaluation of the timing of surgical complications following radical cystectomy

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2015MP65-19 AN EVALUATION OF THE TIMING OF SURGICAL COMPLICATIONS FOLLOWING RADICAL CYSTECTOMY Akshay Sood, Naveen Kachroo, Firas Abdollah, Jesse Sammon, Dane Klett, Wooju Jeong, Adam Kibel, Marianne Schmid, James Peabody, Mani Menon, and Quoc-Dien Trinh Akshay SoodAkshay Sood More articles by this author , Naveen KachrooNaveen Kachroo More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Jesse SammonJesse Sammon More articles by this author , Dane KlettDane Klett More articles by this author , Wooju JeongWooju Jeong More articles by this author , Adam KibelAdam Kibel More articles by this author , Marianne SchmidMarianne Schmid More articles by this author , James PeabodyJames Peabody More articles by this author , Mani MenonMani Menon More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2309AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail 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 30-days 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 (OR=1.02, p<0.001), black race (OR=1.67, p=0.001), and creatinine ≥1.2mg/dl (p=0.002) were significant predictors of pre-discharge complications, while, diabetes (OR=1.40, p<0.001) and advanced cancer (OR=1.35, p=0.007) were significant predictors of post-discharge complications. BMI ≥30 and continent diversions both increased (p<0.01) the odds for both pre- and post-discharge complications. For a given complication, timing did not affect the odds for mortality or re-intervention (OR=0.42, p=0.115; OR=1.51, p=0.875, 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. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e815 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akshay Sood More articles by this author Naveen Kachroo More articles by this author Firas Abdollah More articles by this author Jesse Sammon More articles by this author Dane Klett More articles by this author Wooju Jeong More articles by this author Adam Kibel More articles by this author Marianne Schmid More articles by this author James Peabody More articles by this author Mani Menon More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...