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Age, American Society of Anesthesiologists physical status classification and Charlson score are independent predictors of 90-day mortality after radical cystectomy

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Abstract

Purpose

Radical cystectomy (RC) is a major surgical procedure accompanied with meaningful complications and countable perioperative mortality. To identify the risk factors predicting the perioperative morbidity and mortality is essential. The study aimed to identify relevant, patient-specific factors associated with 90-day mortality following RC, which may serve as a foundation for improving healthcare delivery to patients with bladder cancer.

Methods

We investigated a sample of 1015 consecutive patients in order to identify predictors of 90-day mortality after RC. Beside tumor-related parameters, ASA classification, NYHA, Canadian Cardiovascular Society classification of angina pectoris, Charlson score, age, gender and the single conditions contributing to the Charlson score were included in the multivariable analyses. The patient data were collected retrospectively, except the ASA score that was obtained prospectively.

Results

We identified a model containing the parameters age (OR 1.05, p = 0.023), ASA classification of 3–4 (OR 6.19, p < 0.001) and Charlson score (OR 1.22, p = 0.003) to predict 90-day mortality. Among the single conditions to the Charlson score, moderate or severe renal disease (OR 3.94, p < 0.001) and liver disease (OR 3.24, p = 0.037) were most closely related to 90-day mortality.

Conclusions

Age, ASA classification and Charlson score as well as moderate or severe renal disease and liver disease appear to be independent predictors of 90-day mortality after RC. Given the highly significant association of ASA score with 90-day mortality and the relative ease and width disposability of this measure, this classification should be, after external validation, incorporated into daily clinical practice in treatment of patients planned to RC.

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Author contributions

V. Novotny involved in project development, data collection and manuscript writing. M. Froehner involved in project development, data collection and manuscript writing. R. Koch involved in data analysis. S. Zastrow involved in data collection. U. Heberling involved in data collection and data analysis. S. Leike involved in data collection. M. Hübler involved in data collection and supervision. M.P. Wirth involved in supervision.

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Author notes

    Authors and Affiliations

    1. Department of Urology, University Hospital “Carl Gustav Carus”, Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany

      Vladimir Novotny, Michael Froehner, Stefan Zastrow, Ulrike Heberling, Steffen Leike & Manfred P. Wirth

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

      Rainer Koch

    3. Department of Anesthesiology, University Hospital “Carl Gustav Carus”, Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany

      Matthias Hübler

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    1. Vladimir Novotny
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    Correspondence to Vladimir Novotny.

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    The authors declare that they have no conflict of interest.

    Ethical standard

    This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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    Vladimir Novotny and Michael Froehner have contributed equally to this article.

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    Novotny, V., Froehner, M., Koch, R. et al. Age, American Society of Anesthesiologists physical status classification and Charlson score are independent predictors of 90-day mortality after radical cystectomy. World J Urol 34, 1123–1129 (2016). https://doi.org/10.1007/s00345-015-1744-8

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    • DOI: https://doi.org/10.1007/s00345-015-1744-8

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