Sayyid Rashid K, Magee Diana, Hird Amanda E, Harper Benjamin T, Webb Eric, Fratino Katherine L, Terris Martha K, Madi Rabii, Satkunasivam Raj, Wallis Christopher J D, Klaassen Zachary
Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States.
Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Can Urol Assoc J. 2021 Jan;15(1):E1-E5. doi: 10.5489/cuaj.6490.
Radical cystectomy (RC) is a highly morbid procedure, with 30-day complication rates approaching 31%. Our objective was to determine risk factors for re-operation within 30 days following a RC for non-metastatic bladder cancer.
We included all patients who underwent a RC for non-metastatic bladder cancer using The American College of Surgeons National Surgical Quality Improvement Program database between January 1, 2007 and December 31, 2014. Logistic regression analyses were used to evaluate predictors of re-operation.
A total of 2608 patients were included; 5.8% of patients underwent re-operation within 30 days. On multivariable analysis, increasing body mass index (BMI) (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.07), African American race (vs. Caucasian OR 2.29, 95% CI 1.21-4.34), and history of chronic obstructive pulmonary disease (COPD) (OR 2.33, 95% CI 1.45-3.74) were significant predictors of re-operation within 30 days of RC. Urinary diversion type (ileal conduit vs. continent) and history of chemotherapy or radiotherapy within 30 days prior to RC were not. Patients who underwent re-operation within this timeframe had a significantly higher mortality rate (4.0% vs. 1.6%) and were more likely to experience cardiac (7.2% vs. 1.9%), pulmonary (23.0% vs. 3.0%), neurological (2.0% vs. 0.49%), and venous thromboembolic events (10.5% vs. 5.4%), as well as infectious complications (64.5% vs. 24.1%), with a significantly longer hospital length of stay (16.5 vs. 7.0 days).
Recognizing increasing BMI, COPD, and African American race as risk factors for re-operation within 30 days of RC will allow urologists to preoperatively identify such high-risk patients and prompt them to adopt more aggressive approaches to minimize postoperative surgical complications.
根治性膀胱切除术（RC）是一种具有高发病率的手术，30天并发症发生率接近31%。我们的目的是确定非转移性膀胱癌患者接受RC术后30天内再次手术的风险因素。
我们纳入了2007年1月1日至2014年12月31日期间使用美国外科医师学会国家外科质量改进计划数据库接受非转移性膀胱癌RC手术的所有患者。采用逻辑回归分析来评估再次手术的预测因素。
共纳入2608例患者；5.8%的患者在30天内接受了再次手术。多变量分析显示，体重指数（BMI）增加（比值比[OR]1.04，95%置信区间[CI]1.01 - 1.07）、非裔美国人种族（与白人相比，OR 2.29，95% CI 1.21 - 4.34）以及慢性阻塞性肺疾病（COPD）病史（OR 2.33，95% CI 1.45 - 3.74）是RC术后30天内再次手术的显著预测因素。尿流改道类型（回肠膀胱术与可控性尿流改道术）以及RC术前30天内的化疗或放疗史不是预测因素。在此时间段内接受再次手术的患者死亡率显著更高（4.0%对1.6%），并且更有可能发生心脏（7.2%对1.9%）、肺部（23.0%对3.0%）、神经（2.0%对0.49%）和静脉血栓栓塞事件（10.5%对5.4%），以及感染性并发症（64.5%对24.1%），住院时间显著更长（16.5天对7.0天）。
认识到BMI增加、COPD和非裔美国人种族是RC术后30天内再次手术的风险因素，将使泌尿外科医生能够在术前识别此类高危患者，并促使他们采取更积极的方法来尽量减少术后手术并发症。
