Gender differences in radical cystectomy: complications and blood loss

To review the impact of gender on blood loss, transfusions, and complications. Radical cystectomy is technically different between men and women. Unique to women, dissection of the anterior vaginal wall can be associated with added blood loss.

We analyzed the records of 262 consecutive patients who underwent radical cystectomy for urothelial carcinoma from March 1993 to March 2003. The perioperative variables, amount of blood loss, transfusion requirements, need for intensive care, length of hospitalization, and 30-day complications were examined.

Women accounted for 24% (n = 63) of this series and had a median operative blood loss of 1.4 L compared with 0.5 L in men (P = 0.001). The transfusion rate was 82% in women and 55% in men (P = 0.001), with the median number of units transfused greater in women (3 U versus 2 U, P = 0.043). Also, 31% of women needed intensive care compared with 15% of men (P = 0.004). The median postoperative stay was similar at 9 days for women and 8 days for men (P = 0.099). The incidence of complications was not significantly different statistically between the gender groups, occurring in 43% of women and 33% of men (P = 0.161). Major complications occurred in 8% of women and 7.5% of men, and the most common minor complication was ileus, reported in 19% of women and 14% of men.

Although the overall complications and length of hospital stay were similar between the gender groups, radical cystectomy in women was associated with greater blood loss, transfusion requirements, and intensive care needs.