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Nutritional predictors of complications following radical cystectomy

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Abstract

Purpose

To determine the impact of preoperative nutritional status on the development of surgical complications following cystectomy using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).

Methods

We performed a retrospective review of the NSQIP 2005–2012 Participant Use Data Files. ACS-NSQIP collects data on 135 variables, including pre- and intraoperative data and 30-day postoperative complications and mortality on all major surgical procedures at participating institutions. Preoperative albumin (<3.5 or >3.5 g/dl), weight loss 6 months before surgery (>10 %), and body mass index (BMI) were identified as nutritional variables within the database. The overall complication rate was calculated, and predictors of complications were identified using multivariable logistic regression models.

Results

A total of 1,213 patients underwent cystectomy for bladder cancer between 2005 and 2012. The overall 30-day complication rate was 55.1 % (n = 668). While 14.7 % (n = 102) had a preoperative albumin <3.5 g/dL, 3.4 % had >10 % weight loss in the 6 months prior to surgery and the mean BMI was 28 kg/m2. After controlling for age, sex, medical comorbidities, medical resident involvement, operation year, operative time, and prior operation, only albumin <3.5 g/dl was a significant predictor of experiencing a postoperative complication (p = 0.03). This remained significant when albumin was evaluated as a continuous variable (p = 0.02).

Conclusions

Poor nutritional status measured by serum albumin is predictive of an increased rate of surgical complications following radical cystectomy. This finding supports the importance of preoperative nutritional status in this population and highlights the need for the development of effective nutritional interventions in the preoperative setting.

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Acknowledgments

No additional acknowledgements exist for this paper. The project described was supported by the University Cancer Research Fund and the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grants KL2TR001109 and UL1TR001111.

Conflict of interest

No additional funding sources or conflicts of interest related to this publication are reported by any of the authors.

Ethical standard

The manuscript does not contain clinical studies or patient data. NSQIP data is completely de-identified.

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Authors and Affiliations

  1. Department of Urology, University of North Carolina at Chapel Hill, 170 Manning Drive, 2113 Physicians Office Building, CB#7235, Chapel Hill, NC, 27599-7235, USA

    David C. Johnson, Matthew E. Nielsen, Jonathan E. Matthews, Michael E. Woods, Eric M. Wallen, Raj S. Pruthi & Angela B. Smith

  2. Levine Cancer Institute and McKay Department of Urology, Carolinas Healthcare System, Charlotte, NC, USA

    Stephen B. Riggs

  3. Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC, USA

    Matthew E. Nielsen, Michael E. Woods, Eric M. Wallen, Raj S. Pruthi & Angela B. Smith

  4. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Matthew E. Nielsen & Jonathan E. Matthews

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  1. David C. Johnson
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  2. Stephen B. Riggs
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  3. Matthew E. Nielsen
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  4. Jonathan E. Matthews
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  5. Michael E. Woods
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  6. Eric M. Wallen
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  7. Raj S. Pruthi
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  8. Angela B. Smith
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Corresponding author

Correspondence to Angela B. Smith.

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Johnson, D.C., Riggs, S.B., Nielsen, M.E. et al. Nutritional predictors of complications following radical cystectomy. World J Urol 33, 1129–1137 (2015). https://doi.org/10.1007/s00345-014-1409-z

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  • DOI: https://doi.org/10.1007/s00345-014-1409-z

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