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Which comorbidity classification is best suited to identify patients at risk for 90-day and long-term non-bladder cancer mortality after radical cystectomy?

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Abstract

Purpose

There is no consensus on the best comorbidity measure in candidates for radical cystectomy. The aim of this study was to identify tool best suited to identify patients at risk for 90-day or premature long-term non-bladder cancer mortality.

Methods

We studied 1268 patients who underwent radical cystectomy to identify patients at risk for 90-day and later-than-90-day mortality, respectively. Six classifications were investigated as possible predictors of both types of mortality. Multivariable models including age as continuous variable and each classification separately were calculated. A heuristic ranking was based on the evaluation of the hazard ratios, p values, Akaike’s information criteria, and concerning the logit models also the areas under the curve.

Results

The median follow-up was 5.7 years. Within 90 days after surgery, the mortality rate was 4.2%. The greatest independent contribution concerning the prediction of 90-day mortality was seen with the American Society of Anesthesiologists (ASA) physical status classification (classes 3–4 versus 1–2: hazard ratio 7.98, 95% confidence interval 3.54–18.01, p < 0.0001). In the longer term, countable diseases (Canadian Cardiovascular Society classification of angina pectoris, conditions contributing the Charlson score) were of greater importance. The results of heuristic ranking were confirmed by multivariate analyses including age and all classifications together.

Conclusions

Besides to chronological age, clinicians should pay particular attention to the ASA classification to identify patients at risk for 90-day mortality after radical cystectomy, whereas long-term mortality is more determined by countable comorbid diseases.

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Funding

No funding was obtained for this study.

Author information

Authors and Affiliations

  1. Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Zeisigwaldstrasse 101, 09130, Chemnitz, Germany

    Michael Froehner

  2. Department of Urology, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany

    Michael Froehner, Ulrike Heberling, Vladimir Novotny, Angelika Borkowetz, Manfred P. Wirth & Christian Thomas

  3. Department of Medical Statistics and Biometry, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany

    Rainer Koch

  4. Department of Anesthesiology, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany

    Matthias Hübler

  5. Department of Urology, Städtisches Klinikum Görlitz, Girbigsdorfer Strasse 1-3, 02828, Görlitz, Germany

    Vladimir Novotny

Authors
  1. Michael Froehner
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  2. Rainer Koch
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  3. Ulrike Heberling
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  4. Matthias Hübler
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  5. Vladimir Novotny
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  6. Angelika Borkowetz
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  7. Manfred P. Wirth
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  8. Christian Thomas
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Contributions

MF: protocol/project development, data collection or management, data analysis, manuscript writing/editing. RK: data analysis, manuscript writing/editing. UH: data collection or management, manuscript writing/editing. MH: data collection or management, manuscript writing/editing. VN: data collection or management, manuscript writing/editing. AB: data collection or management, manuscript writing/editing. MPW: manuscript writing/editing, supervision. CT: Manuscript writing/editing, supervision.

Corresponding author

Correspondence to Michael Froehner.

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Conflict of interest

The authors declare no conflict of interest related to this manuscript.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional review board approval was obtained (reference number EK84032009).

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Informed consent was obtained from all individual participants included in the study.

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Froehner, M., Koch, R., Heberling, U. et al. Which comorbidity classification is best suited to identify patients at risk for 90-day and long-term non-bladder cancer mortality after radical cystectomy?. World J Urol 38, 695–702 (2020). https://doi.org/10.1007/s00345-019-02860-1

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  • DOI: https://doi.org/10.1007/s00345-019-02860-1

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