Comprehensive characterization of perioperative reoperation following radical cystectomy

Timothy D. Lyon, Stephen A. Boorjian, Paras H. Shah, Robert Tarrell, John Cheville, Igor Frank, Robert Jeffrey Karnes, R. Houston Thompson, Matthew K. Tollefson

Research output: Contribution to journalArticle

Abstract

Introduction: To examine the nature, timing, and risk factors underlying return to the operating room (ROR) following radical cystectomy (RC). ROR has been proposed as a surgical quality metric based on data from the general surgery literature, but ROR has not been comprehensively characterized following RC. Patients and methods: We queried our institutional Cystectomy Registry from 2000 to 2016 to identify patients with ROR within 90 days of RC. Multivariable logistic regression was used to examine associations between patient features and ROR. Survival outcomes were studied based on whether ROR was necessary. Results: Of 1968 patients treated with RC, 112 (5.7%) underwent 125 reoperations within 90 days of RC, of which 93% were unanticipated and due to postsurgical complications. The most common reasons for ROR were facial dehiscence (29%), bowel obstruction (21%), and enteric anastomotic leak (8%). On multivariable analysis, increasing body mass index (odds ratio 1.04, 95% confidence interval (CI) 1.01–1.08, P = 0.045) and albumin <3.5 g/dl (odds ratio 2.15, 95% CI 1.28–3.59, P = 0.004) were associated with greater odds of ROR. Patients with a ROR had significantly decreased 5-year overall survival compared to patients who did not undergo ROR (43% vs. 55%; P = 0.003), and ROR was associated with increased all-cause mortality after multivariable adjustment (hazard ratio 1.33, 95% CI 1.01–1.74, P = 0.04). Conclusion: ROR principally occurred due to unanticipated complications and was associated with increased mortality after RC. These data suggest ROR may be a useful metric by which urological programs can track the efficacy of interventions aimed at improving perioperative care for RC patients.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Cystectomy
Operating Rooms
Reoperation
Confidence Intervals
Odds Ratio
Perioperative Care
Anastomotic Leak
Survival
Mortality
Registries
Albumins
Body Mass Index
Logistic Models

Keywords

  • Bladder cancer
  • Postoperative complications
  • Radical cystectomy
  • Reoperation

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Lyon, T. D., Boorjian, S. A., Shah, P. H., Tarrell, R., Cheville, J., Frank, I., ... Tollefson, M. K. (Accepted/In press). Comprehensive characterization of perioperative reoperation following radical cystectomy. Urologic Oncology: Seminars and Original Investigations. https://doi.org/10.1016/j.urolonc.2018.11.023

Comprehensive characterization of perioperative reoperation following radical cystectomy. / Lyon, Timothy D.; Boorjian, Stephen A.; Shah, Paras H.; Tarrell, Robert; Cheville, John; Frank, Igor; Karnes, Robert Jeffrey; Thompson, R. Houston; Tollefson, Matthew K.

In: Urologic Oncology: Seminars and Original Investigations, 01.01.2019.

Research output: Contribution to journalArticle

Lyon, Timothy D. ; Boorjian, Stephen A. ; Shah, Paras H. ; Tarrell, Robert ; Cheville, John ; Frank, Igor ; Karnes, Robert Jeffrey ; Thompson, R. Houston ; Tollefson, Matthew K. / Comprehensive characterization of perioperative reoperation following radical cystectomy. In: Urologic Oncology: Seminars and Original Investigations. 2019.
@article{da70d3ba3f45459e869bbfc26c98e2b0,
title = "Comprehensive characterization of perioperative reoperation following radical cystectomy",
abstract = "Introduction: To examine the nature, timing, and risk factors underlying return to the operating room (ROR) following radical cystectomy (RC). ROR has been proposed as a surgical quality metric based on data from the general surgery literature, but ROR has not been comprehensively characterized following RC. Patients and methods: We queried our institutional Cystectomy Registry from 2000 to 2016 to identify patients with ROR within 90 days of RC. Multivariable logistic regression was used to examine associations between patient features and ROR. Survival outcomes were studied based on whether ROR was necessary. Results: Of 1968 patients treated with RC, 112 (5.7{\%}) underwent 125 reoperations within 90 days of RC, of which 93{\%} were unanticipated and due to postsurgical complications. The most common reasons for ROR were facial dehiscence (29{\%}), bowel obstruction (21{\%}), and enteric anastomotic leak (8{\%}). On multivariable analysis, increasing body mass index (odds ratio 1.04, 95{\%} confidence interval (CI) 1.01–1.08, P = 0.045) and albumin <3.5 g/dl (odds ratio 2.15, 95{\%} CI 1.28–3.59, P = 0.004) were associated with greater odds of ROR. Patients with a ROR had significantly decreased 5-year overall survival compared to patients who did not undergo ROR (43{\%} vs. 55{\%}; P = 0.003), and ROR was associated with increased all-cause mortality after multivariable adjustment (hazard ratio 1.33, 95{\%} CI 1.01–1.74, P = 0.04). Conclusion: ROR principally occurred due to unanticipated complications and was associated with increased mortality after RC. These data suggest ROR may be a useful metric by which urological programs can track the efficacy of interventions aimed at improving perioperative care for RC patients.",
keywords = "Bladder cancer, Postoperative complications, Radical cystectomy, Reoperation",
author = "Lyon, {Timothy D.} and Boorjian, {Stephen A.} and Shah, {Paras H.} and Robert Tarrell and John Cheville and Igor Frank and Karnes, {Robert Jeffrey} and Thompson, {R. Houston} and Tollefson, {Matthew K.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.urolonc.2018.11.023",
language = "English (US)",
journal = "Urologic Oncology",
issn = "1078-1439",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Comprehensive characterization of perioperative reoperation following radical cystectomy

AU - Lyon, Timothy D.

AU - Boorjian, Stephen A.

AU - Shah, Paras H.

AU - Tarrell, Robert

AU - Cheville, John

AU - Frank, Igor

AU - Karnes, Robert Jeffrey

AU - Thompson, R. Houston

AU - Tollefson, Matthew K.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: To examine the nature, timing, and risk factors underlying return to the operating room (ROR) following radical cystectomy (RC). ROR has been proposed as a surgical quality metric based on data from the general surgery literature, but ROR has not been comprehensively characterized following RC. Patients and methods: We queried our institutional Cystectomy Registry from 2000 to 2016 to identify patients with ROR within 90 days of RC. Multivariable logistic regression was used to examine associations between patient features and ROR. Survival outcomes were studied based on whether ROR was necessary. Results: Of 1968 patients treated with RC, 112 (5.7%) underwent 125 reoperations within 90 days of RC, of which 93% were unanticipated and due to postsurgical complications. The most common reasons for ROR were facial dehiscence (29%), bowel obstruction (21%), and enteric anastomotic leak (8%). On multivariable analysis, increasing body mass index (odds ratio 1.04, 95% confidence interval (CI) 1.01–1.08, P = 0.045) and albumin <3.5 g/dl (odds ratio 2.15, 95% CI 1.28–3.59, P = 0.004) were associated with greater odds of ROR. Patients with a ROR had significantly decreased 5-year overall survival compared to patients who did not undergo ROR (43% vs. 55%; P = 0.003), and ROR was associated with increased all-cause mortality after multivariable adjustment (hazard ratio 1.33, 95% CI 1.01–1.74, P = 0.04). Conclusion: ROR principally occurred due to unanticipated complications and was associated with increased mortality after RC. These data suggest ROR may be a useful metric by which urological programs can track the efficacy of interventions aimed at improving perioperative care for RC patients.

AB - Introduction: To examine the nature, timing, and risk factors underlying return to the operating room (ROR) following radical cystectomy (RC). ROR has been proposed as a surgical quality metric based on data from the general surgery literature, but ROR has not been comprehensively characterized following RC. Patients and methods: We queried our institutional Cystectomy Registry from 2000 to 2016 to identify patients with ROR within 90 days of RC. Multivariable logistic regression was used to examine associations between patient features and ROR. Survival outcomes were studied based on whether ROR was necessary. Results: Of 1968 patients treated with RC, 112 (5.7%) underwent 125 reoperations within 90 days of RC, of which 93% were unanticipated and due to postsurgical complications. The most common reasons for ROR were facial dehiscence (29%), bowel obstruction (21%), and enteric anastomotic leak (8%). On multivariable analysis, increasing body mass index (odds ratio 1.04, 95% confidence interval (CI) 1.01–1.08, P = 0.045) and albumin <3.5 g/dl (odds ratio 2.15, 95% CI 1.28–3.59, P = 0.004) were associated with greater odds of ROR. Patients with a ROR had significantly decreased 5-year overall survival compared to patients who did not undergo ROR (43% vs. 55%; P = 0.003), and ROR was associated with increased all-cause mortality after multivariable adjustment (hazard ratio 1.33, 95% CI 1.01–1.74, P = 0.04). Conclusion: ROR principally occurred due to unanticipated complications and was associated with increased mortality after RC. These data suggest ROR may be a useful metric by which urological programs can track the efficacy of interventions aimed at improving perioperative care for RC patients.

KW - Bladder cancer

KW - Postoperative complications

KW - Radical cystectomy

KW - Reoperation

UR - http://www.scopus.com/inward/record.url?scp=85060213159&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060213159&partnerID=8YFLogxK

U2 - 10.1016/j.urolonc.2018.11.023

DO - 10.1016/j.urolonc.2018.11.023

M3 - Article

JO - Urologic Oncology

JF - Urologic Oncology

SN - 1078-1439

ER -