Complications in the Early Recovery Period After Radical Cystectomy-Real Data From Impartial Inpatient Rehabilitation

Area of Science:

• Urology
• Surgical Oncology
• Oncology

Background:

• Radical cystectomy (RC) is a standard treatment for muscle-invasive bladder cancer.
• Urinary diversion, including ileum conduit (IC) and neobladder (NB) creation, is performed after RC.
• Understanding postoperative complications and risk factors is crucial for patient management.

Purpose of the Study:

• To examine postoperative complications following radical cystectomy (RC) with either ileum conduit (IC) or neobladder (NB) creation.
• To identify preoperative risk factors associated with these complications in bladder cancer patients.

Main Methods:

• Prospective data from 842 patients undergoing RC and urinary diversion (IC n=447, NB n=395) between April 2018 and December 2019 were analyzed.
• Postoperative complications were assessed using the Clavien-Dindo classification until the end of inpatient rehabilitation (IR).
• Univariate and multivariate analyses identified predictors for overall and high-grade complications.

Main Results:

• A total of 2689 complications occurred in 813 patients (96.6%).
• High-grade complications were more frequent before IR (25.5%) than during IR (5.7%).
• Independent predictors for overall complications included NB creation (OR 21.520), age ≥70 (OR 2.522), and higher BMI (OR 1.153). NB creation (OR 1.448) and Charlson Comorbidity Index ≥2 (OR 1.999) predicted high-grade complications.

Conclusions:

• Postoperative complication rates after RC with IC or NB creation are higher than previously reported.
• A significant proportion of low-grade complications occur after hospital discharge.
• Despite high complication rates, the hospital readmission rate was lower than historical data.