Short-Term Morbidity and Mortality in Patients Undergoing Radical Cystectomy at a Tertiary Care Center: A Prospective...

Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer (MIBC) but is associated with significant perioperative morbidity and mortality. This study evaluates short-term (90-day) morbidity and mortality outcomes following RC at Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, to identify complications and risk factors.

This prospective observational study, conducted from February 2023 to July 2025, included 173 patients undergoing RC for MIBC or high-risk non-MIBC (NMIBC) at SKIMS. Patients underwent RC with ileal conduit (IC) or orthotopic neobladder (NB) diversion. Complications within 90 days were graded using the Clavien-Dindo classification. Data on preoperative, operative, and postoperative variables were analyzed using IBM SPSS Statistics for Windows, version 24, with associations tested at a 5% significance level (P < 0.05).

Of 173 patients (86.7% male, mean age 59.9 years), 52.6% (91/173) experienced complications, with 15.6% (27/173) classified as major (Grades 3-5). The most frequent complications were superficial wound infections (9.8%), postoperative blood transfusions (8.7%), and subacute intestinal obstruction (5.8%). The 90-day mortality rate was 3.4% (6/173), primarily due to septic shock and cardiovascular events. Predictors of complications included diabetes mellitus, advanced disease stage, higher American Society of Anesthesiologists (ASA) score, low preoperative hemoglobin, low serum albumin, longer operative time, and increased blood loss. Orthotopic NB patients had longer operative times and hospital stays but fewer complications due to selective patient criteria.

RC at SKIMS carries a 52.6% complication rate and 3.4% mortality rate within 90 days. Optimizing patient selection, surgical techniques, and perioperative care is critical to reducing morbidity and improving outcomes in this high-risk procedure.