Radical cystectomy (RC) complications overall appear to be decreasing in the United States but further improvements are needed, investigators reported in a poster presentation at the American Urological Association’s 2022 annual meeting in New Orleans, Louisiana.
Using the 2006-2018 National Surgical Quality Improvement Program (NSQIP) database, investigators identified 11,351 RC cases. Mean length of hospital stay significantly decreased from 10.5 to 9.8 to 8.6 days, across the 3 contemporary eras: 2006-2011, 2012-2014, and 2015-2018, respectively, likely reflecting improvements in perioperative care, Kevin Chua, MD, of Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, reported on behalf of his team.
The readmission rate held steady at 20.0%, 21.3%, and 21.0%, respectively. The 30-day mortality rate also remained unchanged at 2.7%, 1.7%, and 2.0%, respectively.
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The rate of any postoperative complication significantly decreased from 56.5% in 2006-2011 to 50.6% in 2015-2018, Dr Chua reported. The rate of major complications within 30 days of RC did not change significantly. The sepsis rate remained high. Deep incisional surgical site infections, however, decreased from 1.9% to 0.8%. Pulmonary embolism significantly decreased from 3.0% to 1.5%.
The rate of minor complications within 30 days of RC significantly declined from 46.4% in 2006-2011 to 41.0% in 2015-2018. Superficial surgical site infections significantly decreased from 6.5% to 4.6% and transfusions from 34.2% to 31.7% over the 12-year span. But the rate of urinary tract infections (UTI) stayed the same.
According to Dr Chua, beneficial changes in perioperative bladder cancer management such as increased use of neoadjuvant chemotherapy, enhanced recovery after surgery protocols, and laparoscopic/robotic techniques likely account for recent improvements. “Further efforts to improve care must target infectious complications and readmissions,” he emphasized.
Reference
Chua K, Patel H, Srivastava A, et al. Contemporary analysis of cystectomy complications. Presented at: AUA 2022; May 13-16, 2022, New Orleans, Louisiana. Abstract MP03-20.
