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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.