Gurayah Aaron A, Blachman-Braun Ruben, Machado Christopher J, Mason Matthew M, Hougen Helen Y, Mouzannar Ali, Gonzalgo Mark L, Nahar Bruno, Punnen Sanoj, Parekh Dipen J, Ritch Chad R
University of Miami Miller School of Medicine Miami Florida USA.
Desai Sethi Urology Institute University of Miami Miller School of Medicine Miami Florida USA.
BJUI Compass. 2023 Dec 5;5(4):480-488. doi: 10.1002/bco2.315. eCollection 2024 Apr.
The objective of this study is to investigate the association between major adverse cardiac events (MACE) and clinical factors of patients undergoing radical cystectomy (RC) for bladder cancer.
A retrospective analysis using the 2015-2020 National Surgical Quality Improvement Program database was performed on patients who underwent RC for bladder cancer. MACE was defined as any report of cerebrovascular accident, myocardial infarction, or thromboembolic events (pulmonary embolism or deep vein thrombosis). A multivariable-adjusted logistic regression was conducted to identify clinical predictors of postoperative MACE.
A total of 10 308 (84.2%) patients underwent RC with incontinent urinary diversion (iUD), and 1938 (15.8%) underwent RC with continent urinary diversion (cUD). A total of 629 (5.1%) patients recorded a MACE, and on the multivariable-adjusted logistic regression, it was shown that MACE was significantly associated with increased age (OR = 1.035, 95% CI: 1.024-1.046, < 0.001), obesity (OR = 1.583, 95% CI: 1.266-1.978, < 0.001), current smokers (OR = 1.386, 95% CI: 1.130-1.700, = 0.002), congestive heart failure before surgery (OR = 1.991, 95% CI: 1.016-3.900; = 0.045), hypertension (OR = 1.209, 95% CI: 1.016-1.453, = 0.043), and increase the surgical time (per 10 min increase, OR = 1.010, 95% CI: 1.003-1.017, = 0.009). We also report that increased age, obesity, and patients undergoing cUD (OR = 1.368, 95% CI: 1.040-1.798; = 0.025) are associated with thromboembolic events.
By considering the preoperative characteristics of patients, including age, obesity, smoking, congestive heart failure, and hypertension status, urologists may be able to decrease the incidence of MACE in patients undergoing RC. Urologists should aim for lower operative times as this was associated with a decreased risk of thromboembolic events.
本研究的目的是调查接受膀胱癌根治性膀胱切除术（RC）患者的主要不良心脏事件（MACE）与临床因素之间的关联。
对2015 - 2020年国家外科质量改进计划数据库中接受膀胱癌RC手术的患者进行回顾性分析。MACE定义为任何关于脑血管意外、心肌梗死或血栓栓塞事件（肺栓塞或深静脉血栓形成）的报告。进行多变量调整的逻辑回归以确定术后MACE的临床预测因素。
共有10308例（84.2%）患者接受了尿流改道的RC手术，1938例（15.8%）患者接受了可控性尿流改道的RC手术。共有629例（5.1%）患者记录了MACE，在多变量调整的逻辑回归分析中显示，MACE与年龄增加（OR = 1.035，95% CI：1.024 - 1.046，P < 0.001）、肥胖（OR = 1.583，95% CI：1.266 - 1.978，P < 0.001）、当前吸烟者（OR = 1.386，95% CI：1.130 - 1.700，P = 0.002）、术前充血性心力衰竭（OR = 1.991，95% CI：1.016 - 3.900；P = 0.045）、高血压（OR = 1.209，95% CI：1.016 - 1.453，P = 0.043）以及手术时间增加（每增加10分钟，OR = 1.010，95% CI：1.003 - 1.017，P = 0.009）显著相关。我们还报告年龄增加、肥胖以及接受可控性尿流改道的患者（OR = 1.368，95% CI：1.040 - 1.798；P = 0.025）与血栓栓塞事件相关。
通过考虑患者的术前特征，包括年龄、肥胖、吸烟、充血性心力衰竭和高血压状况，泌尿外科医生可能能够降低接受RC手术患者的MACE发生率。泌尿外科医生应争取缩短手术时间，因为这与血栓栓塞事件风险降低相关。
