Study: Cystectomy Complication Rate Not Improving
Researchers find no significant change in overall complication rate from 2010 to 2015, but hospital length of stay and need for transfusion have declined.
Perioperative complication rates following radical cystectomy (RC) for bladder cancer have not declined despite enhanced recovery protocols, but hospital length of stay (LOS) and need for blood transfusions have declined, a new study finds.
Using the National Surgical Quality Improvement Program (SQIP), researchers identified 6510 patients who underwent RC from 2010 to 2015. Of these, 31.5% experienced a complication within 30 days. The complication rate was 28%, 32%, 31%, 32%, 32%, and 31% in 2010, 2011, 2012, 2013, 2014, and 2015, respectively.
Infections were the most common complication (16.7%), followed by wound (14.3%) and pulmonary complications (5.7%). Overall, 5.6% of patients required reoperation (Clavien III), and 8.7% had a life-threatening Clavien IV complication. The 30-day mortality rate (Clavien V) was 1.8%. The proportion of patients requiring blood transfusion declined significantly from 40% in 2010 to 37% in 2015. Hospital LOS dropped from 10.6 to 9.2 days during the study period.
Among all patients, 5.8% underwent robotic cystectomy and 15.9% had a continent urinary diversion, with fewer procedures in recent years.
“Although our study did not find any significant change in the rate of complications, the gradual reduction in LOS and transfusion suggests that care following RC is changing,” Scott C. Johnson, MD, and colleagues at the University of Chicago wrote in Urologic Oncology. “Whether this change is a result of increasing adoption of specific interventions, standardization of care, financial pressures, or other factors is not clear. Regardless, RC is a morbid procedure and there remains significant room for improvement. Development of new strategies to limit morbidity are needed, as are efforts to increase usage of known best practices.”
With regard to study limitations, Dr Johnson's group noted that the NSQIP database does not include information on gastrointestinal complications, which frequently cited as the most common group of complications following RC. The researchers also lacked information on disease characteristics and use of neoadjuvant chemotherapy.
Johnson SC, Smith ZL, Golan S, Rodriguez III JF, Smith ND, Steinberg GD. Temporal trends in perioperative morbidity for radical cystectomy using the National Surgical Quality Improvement Program database. Urol Onc. doi: 10.1016/j.urolonc.2017.07.013