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Prediction of early (30-day) and late (30–90-day) mortality after radical cystectomy in a comprehensive cancer centre over two decades

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Abstract

Background

Radical cystectomy (RC) is associated with substantial postoperative mortality. In this study, we analyzed early (30-day; 30 M) and late (30–90-day; 30–90 M) mortality after RC in a Dutch tertiary referral center and determined factors associated with 30 M, 30–90 M and 90-day mortality (90 M).

Patients and methods

We identified 823 patients who underwent RC for bladder cancer in the Netherlands Cancer Institute between 1997 and 2017. Predictive factors for mortality were analyzed to identify patients with a higher mortality risk. Multivariate logistic regression analysis was performed to examine the influence of patient, surgical and histopathological variables on 30 M, 30–90 M and 90 M.

Results

Thirty-day mortality was 1.9% and 90 M was 6.0%. Multivariable analysis showed that age (OR 1.08, 95% CI 1.01–1.1, p = 0.002) and ASA 3–4 (OR 3.57, 95% CI 1.25–10.16, p = 0.002) were significant predictors of 30 M while higher ASA score (OR 2.9, 95% CI 1.31–6.5, p = 0.009) and higher pathological T stage (OR 8.8, 95% CI 1.9–40.4, p = 0.005) were associated with 30–90 M. Risk of 90 M was increased in patients with ASA 3–4 (OR 2.4, 95% CI 1.2–4.9, p = 0.01), pT3–4 (OR 3.1, 95% CI 1.27–7.57, p = 0.01) and positive LNs (OR 2.5, 95% CI 1.25–4.98, p = 0.009).

Conclusions

Patient-related factors predicted 30 M whereas both patient-related and cancer-related factors predicted 30–90 M. This suggests that patient mix, i.e. patient- vs. cancer-related factors for 30 M and 30–90 M, should be taken into account if mortality rates are to be compared between hospitals.

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Acknowledgements

The authors would like to thank Marja van Rijn for assistance.

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None.

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Authors and Affiliations

  1. Department of Surgical Oncology (Urology), Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    M. L. Korbee, C. S. Voskuilen, K. Hendricksen, E. M. Wit, P. J. van Leeuwen, S. Horenblas, W. Meinhardt, A. Bex, H. G. van der Poel & B. W. G. van Rhijn

  2. Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany

    R. Mayr, M. Burger & B. W. G. van Rhijn

  3. Department of Urology, Royal Free London NHS Foundation Trust, University College London, London, UK

    A. Bex

Authors
  1. M. L. Korbee
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  2. C. S. Voskuilen
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  3. K. Hendricksen
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  4. R. Mayr
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  5. E. M. Wit
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  6. P. J. van Leeuwen
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  7. S. Horenblas
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  8. W. Meinhardt
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  9. M. Burger
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  10. A. Bex
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  11. H. G. van der Poel
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  12. B. W. G. van Rhijn
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Contributions

MLK: Project development, data collection and management, data analysis, manuscript writing. CSV: Project development, data collection, data analysis, manuscript editing. KH: Manuscript editing. RM: Manuscript editing. EM: Manuscript editing. PJL: Manuscript editing. SH: Manuscript editing. WM: Manuscript editing. MB: Manuscript editing. AB: Manuscript editing. HGP: Manuscript editing, supervision. BWGR: Project development, manuscript editing, supervision.

Corresponding author

Correspondence to B. W. G. van Rhijn.

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The authors declare that they have no conflict of interest.

Research involving human participants

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee (Institutional Review Board, protocol numbers: CFMPB104 and CFMPB160) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent was not required.

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Korbee, M.L., Voskuilen, C.S., Hendricksen, K. et al. Prediction of early (30-day) and late (30–90-day) mortality after radical cystectomy in a comprehensive cancer centre over two decades. World J Urol 38, 2197–2205 (2020). https://doi.org/10.1007/s00345-019-03011-2

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  • DOI: https://doi.org/10.1007/s00345-019-03011-2

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