Perioperative Complications and Mortality After Radical Cystectomy When Using a Standardized Reporting Methodology

详细信息    查看全文

• 作者：Riccardo Schiavina¹ ; ^{rschiavina@yahoo.it} ; Marco Borghesi¹ ; Mascia Guidi¹ ; Valerio Vagnoni¹ ; Ziv Zukerman¹ ; Cristian Pultrone¹ ; Giovanni Passaretti¹ ; Daniele Romagnoli¹ ; Lorenzo Bianchi¹ ; Antonio Morselli-Labate² ; Eugenio Brunocilla¹ ; Marco Garofalo¹ ; Fabio Manferrari¹ ; Sergio Concetti¹ ; Giuseppe Martorana¹
• 关键词：Mortality ; Postoperative complications ; Radical cystectomy ; Transitional cell carcinoma ; Urinary diversion
• 刊名：Clinical Genitourinary Cancer
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：11
• 期：2
• 页码：189-197
• 全文大小：311 K

文摘

Purpose

To evaluate, by using a standardized reporting methodology, the perioperative complications and mortality in patients who underwent radical cystectomy.

Materials and Methods

We retrospectively reviewed all data of 404 consecutive patients who underwent radical cystectomy from 1995 to 2009 for nonmetastatic bladder cancer at the same academic center. Perioperative complications and perioperative mortality were defined as any adverse event or death from any cause within 90 days of surgery. All perioperative complications were reported according to the Martin criteria and were graded according to the Clavien system (grade 1-5). Univariate and multivariate analyses for the clinical and pathologic characteristics were used to evaluate predictors of complications.

Results

A total of 296 complications occurred in 209 (51.7 % ) patients. Among them, 139 (34.4 % of the entire population) had only a ¡®¡°minor¡±' (grade 1-2) complication, whereas 70 (17.3 % ) had a ¡°major¡± (grade 3-5) complication. Eighteen (4.5 % ) patients died within 90 days after surgery. At univariate analysis, age ¡Ý75 years (2P = .018), serum creatinine level ¡Ý1.4 mg/dL (2P = .025), American Society of Anesthesiologists (ASA) score of 3 to 4 (2P < .001) were significant predictors of complications after 30 days from surgery; conversely, the ASA score was the only significant predictor of complications after 90 days. At multivariate analysis, only the ASA score was independently correlated with the development of complications at 30 and 90 days of follow-up (2P < .001).

Conclusions

Radical cystectomy is one of the most complex procedures in urology, with a high rate of complications and mortality. The use of a standardized methodology is the only way to estimate the actual rate and the severity of complications.