Contemporary trends of in-hospital complications and mortality for radical cystectomy

Study Type - Therapy (trend analysis) Level of Evidence 2b What's known on the subject? and What does the study add? Radical cystectomy (RC) carries significant risks of morbidity and mortality. Little is known whether in-hospital outcomes are improving for RC. Using a contemporary population-based cohort, the present study suggests minimal improvement in postoperative complications and mortality overall or by hospital-volume category from 2001 to 2008. About 29% and 2% of patients undergoing RC will experience a postoperative complication or die during hospitalisation, respectively. OBJECTIVE To characterise the contemporary trends of in-hospital complications and mortality for radical cystectomy (RC) from a contemporary population-based cohort, as patients undergoing RC for bladder cancer are at significant risk for complications and mortality and the degree to which in-hospital outcomes have changed over time is unknown. PATIENTS AND METHODS We identified 50 625 individuals who underwent RC for bladder cancer between 2001 and 2008 from the Nationwide Inpatient Sample. Multivariable regression models were used to identify hospital and patient covariates associated with in-hospital complications and mortality and to estimate predicted probabilities of each outcome. Temporal trends of in-hospital mortality and complications were assessed by Wilcoxon rank-sum test. RESULTS The proportion of patients with in-hospital complications remained stable at 28.3% in 2001-2002 compared with 28.0% in 2007-2008 (P= 0.81 for trend). In-hospital mortality was also unchanged from 2.4% in 2001-2002 compared with 2.3% in 2007-2008 (P= 0.87 for trend). While high-volume hospitals were associated with lower odds of in-hospital complications (odds ratio [OR] 0.77, P= 0.01) and mortality (OR 0.60, P= 0.02) compared with low-volume hospitals, the predicted probabilities of in-hospital complications or mortality were unchanged within each volume category between 2001 and 2008. CONCLUSIONS In-hospital complications and mortality for RC remain unchanged from 2001 to 2008. While high-volume hospitals continue to have better outcomes, there is little evidence that postoperative mortality and morbidity are improving among low-, medium- and high-volume hospitals. Increased attention is needed to identify the modifiable aspects of postoperative care to improve in-hospital outcomes and safety for patients undergoing RC.