Urologic Cancer Surgery Readmission Rate Highest for RC

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In a study, nearly 20% of radical cystectomy patients were readmitted for complications within 90 days compared with 1.9% and 5.9% for radical prostatectomy and radical nephrectomy, respectively.
In a study, nearly 20% of radical cystectomy patients were readmitted for complications within 90 days compared with 1.9% and 5.9% for radical prostatectomy and radical nephrectomy, respectively.
The following article is part of conference coverage from the 2018 Genitourinary Cancers Symposium in San Francisco. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from GU 2018.

SAN FRANCISCO—Postoperative complication rates and mortality risk within 90 days are higher for radical cystectomy (RC) than radical nephrectomy (RN) or radical prostatectomy (RP), according to study findings presented at the 2018 Genitourinary Cancers Symposium.

Investigators found that the 90-day complication rate was 68.3% for RC, followed by 39% for RN, and 14.2% for RP. Of the RP, RN, and RC patients, 1.9%, 5.9%, and 19.9% were readmitted for complications in 90 days.

For RC and RN, a complication resulting in readmission compared with an index complication nearly doubled the predicted probability of mortality, according to Matthew Mossanen, MD, and colleagues at Brigham and Women's Hospital and Harvard Medical School in Boston. For RC patients, the probability of death increased from 3.9% for an index complication to 6.8% for a readmission complication. For RN patients, the probability of death rose from 1.7% to 3.6%. Among the RP patients, the predicted probability of death was less than 1% following the index and readmission complication.

Results also showed that the more complications patients experienced during the index stay and on readmission, the greater the impact on mortality. For RC and RN patients, 4 complications resulted in a nearly 3-fold increase in the predicted probability of death compared with 1 complication.

Cardiac and pulmonary complications had the biggest impact on 90-day postoperative mortality. Index cardiac complications following RP, RN, and RC increased the odds of death by a significant 47.6 times, 6.9 times, and 4.4 times greater odds of death, respectively. Index pulmonary complications increased the odds of death by a significant 16.9 times, 5.0 times, and 6.5 times, respectively.

“These data can be considered for assessing and guiding quality and value of care initiatives in major urologic cancer surgery,” the authors concluded.

The study cohort included 630,828 RP patients, 306,532 RN patients, and 57,533 RC patients. Patients had a mean age of 62, 63, and 69 years, respectively.

Visit Renal and Urology News' conference section for continuous coverage from GU 2018.

Reference

Massanen M, Krasnow RE, Zlatev DV, et al. Incidence and predictors of mortality following major urologic cancer surgery. Data presented at the 2018 Genitourinary Cancers Symposium, held in San Francisco Feb. 8-10. Abstract 435.

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