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Measurement of Perioperative Risk and Outcomes for Bladder Cancer Patients Undergoing Radical Cystectomy Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Database
Jason R. Gee, M.D., John A. Libertino, MD, Andrea Sorcini, MD, Ali Moinzadeh, MD, David Canes, MD, Karim J. Hamawy, MD.
Lahey Clinic, Burlington, MA, USA.

INTRODUCTION: Radical cystectomy remains the gold standard for treating muscle-invasive bladder cancer although with significant morbidity. NSQIP permits site-specific evaluation of pre-operative risk factors and outcomes for patients undergoing radical cystectomy as compared to nationwide experience. Here we evaluate a contemporary cohort of patients undergoing radical cystectomy at a tertiary referral center utilizing NSQIP findings.
METHODS: From January to December 2011, 926 patients from 28 participating NSQIP sites nationwide underwent radical cystectomy of which 79 (9%) of these 926 were performed at our institution. Pre-operative risk factors include BMI, performance status, cardiovascular, pulmonary, cerebrovascular, nutritional and metabolic disorders, alcohol and tobacco use. Specific post-operative adverse events were organized in terms of wound, respiratory, cardiovascular, renal and infectious complications.
RESULTS: The average age of our patients undergoing cystectomy was 69.8 years of which 20% were 80-88yrs. Preoperative risks for our series were higher in terms of hypertension (74.4% versus 57.0%) and severe COPD (12.8% versus 7.7%) but were otherwise similar to national data. Post-operative urinary tract infections were higher in our series (18.3% versus 8.9%) although major categories including wound, respiratory, cardiovascular, and renal complications were similar to national statistics.
CONCLUSIONS: With a relatively high volume of patients undergoing radical cystectomy, our post-operative outcomes compared favorably with nationwide data, even with less favorable pre-operative risks including hypertension and severe COPD. While other factors may be implicated, patient selection in terms of pre-operative risks and high volume experience can contribute favorably to patient outcomes following radical cystectomy as demonstrated in this study.


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