Anemia increases the risk for major complications after radical cystectomy, a new study finds.

Of 83,470 patients in the US Premier Hospital Database who underwent radical cystectomy from 2003 to 2017, 11.3% had documented anemia.

On multivariable analysis, preoperative anemia was associated with 2.2-fold increased odds of experiencing any complication within 90 days compared with no anemia, Filipe L.F. Carvalho, MD, PhD, of Brigham and Women’s Hospital in Boston, Massachusetts, and colleagues reported in Urologic Oncology. Anemia significantly increased the odds of major (Clavien grade 3-4) complications by 1.5 fold. By organ system, anemia significantly increased the odds of genitourinary, renal, gastrointestinal, pulmonary, and infectious complications.

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Over 90 days, direct hospital costs were $1233 higher for patients with than without preoperative anemia. The main expenses included laboratory tests, medication, radiology exams, and operating room costs. Surgery times were not longer for patients with anemia, but they had higher resource use. Hospital readmission rates and length of stay did not differ significantly between groups.

Anemia often indicates malnutrition, frailty, and poor performance status, the investigators noted. Up to half of cystectomy patients meet criteria for being malnourished, they revealed. Patients with anemia in this cohort also tended to have a Charlson Comorbidity Index of 2 or greater.

Preoperative anemia is an objective measure and can be used to identify those at higher risk of developing complications or those who need to be monitored closely, according to Dr Carvalho’s team. Incorporating hemoglobin levels in risk stratification and managing iron deficiency may help inform preoperative counseling, they noted.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Carvalho FLF, Wang Y, Dall CP, et al. Preoperative anemia is associated with increased radical cystectomy complications. Urol Oncol. Published online June 8, 2022. doi:10.1016/j.urolonc.2022.04.014