Radical cystectomy outcomes ‘unchanged in a decade’
MedWire News: Rates of in-hospital complications and mortality in patients undergoing radical cystectomy have not changed in the past decade, research shows.
The study authors call for greater attention to be paid to postoperative care in order to improve outcomes and safety for patients undergoing the procedure.
Radical cystectomy has traditionally been associated with a high risk for both surgical and postdischarge complications, but the impact of contemporary management trends - including the move towards increased referral to high-volume centers - is not known.
To investigate, Nilay Shah (Mayo Clinic, Rochester, Minnesota, Minneapolis, USA) and team used national data to identify 50,625 individuals who had undergone radical cystectomy for bladder cancer between 2001 and 2008.
Writing in the British Journal of Urology International, they report that the proportion of patients with in-hospital complications was 28.3% in 2001-2002 and 28.0% in 2007-2008, indicating no change.
Similarly, in-hospital mortality was unchanged from 2.4% in 2001-2001 to 2.3% in 2007-2008.
In a multivariate analysis, treatment in high-volume hospitals was a significant predictor for better outcomes, including fewer in-hospital complications (odds ratio [OR]=0.77) and lower mortality (OR=0.60), compared with low-volume hospitals.
However, when outcomes were stratified by hospital volume, rates of complications and mortality within each volume category were unchanged between 2001 and 2008.
Commenting on their findings, Shah et al write: "Our study indicates that patients undergoing radical cystectomy for bladder cancer remained at significant, yet stable risk of postoperative morbidity and mortality between 2001 and 2008 in a contemporary population-based cohort in the USA.
"Increased attention to identifying the modifiable aspects of postoperative care is therefore to improve the in-hospital outcomes and safety of patients who undergo radical cystectomy for bladder cancer."
By Joanna Lyford