Gender differences in radical cystectomy: complications and blood loss

Lee, Keith L.; Freiha, Fuad S.; Presti, Joseph C.; Gill, Harcharan

doi:10.1016/j.urology.2004.01.029

Cited by 56 publications

(40 citation statements)

References 13 publications

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“…26,27 It should also be noted that women were had higher odds of pOT and transfusions. This is in line with previous studies, 20,28 and highlights that RC might be more challenging in women.…”

Section: Discussionsupporting

confidence: 93%

Short-term perioperative outcomes of patients treated with radical cystectomy for bladder cancer included in the National Surgical Quality Improvement Program (NSQIP) database

Gandaglia

Varda

Sood

et al. 2014

CUAJ

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Introduction: We report the contemporary outcomes of radical cystectomy (RC) in patients with bladder cancer using a national, prospective perioperative database specifically developed to assess the quality of surgical care. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2006 to 2011 for RC. Data on postoperative complications, operative time, length of stay, blood transfusions, readmission, and mortality within 30 days from surgery were abstracted. Results: Overall, 1094 patients undergoing RC were identified. Rates of overall complications, transfusions, prolonged length of hospitalization, readmission, and perioperative mortality were 31.1%, 34.4%, 25.9%, 20.2%, and 2.7%, respectively. Body mass index represented an independent predictor of overall complications on multivariate analysis (p = 0.04). Baseline comorbidity status was associated with increased odds of postoperative complications, prolonged operative time, transfusion, prolonged hospitalization, and perioperative mortality. In particular, patients with cardiovascular comorbidities were 2.4 times more likely to die within 30 days following cystectomy compared to their healthier counterparts (p = 0.04). Men had lower odds of prolonged operative time and blood transfusions (p ≤ 0.03). Finally, the receipt of a continent urinary diversion was the only predictor of readmission (p = 0.02). Our results are limited by their retrospective nature and by the lack of adjustment for hospital and tumour volume. Conclusions: Complications, transfusions, readmission, and perioperative mortality remain relatively common events in patients undergoing RC for bladder cancer. In an era where many advocate the need for prospective multi-institutional data collection as a means of improving quality of care, our study provides data on short-term outcomes after RC from a national quality improvement initiative.

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Section: Discussionsupporting

confidence: 93%

Short-term perioperative outcomes of patients treated with radical cystectomy for bladder cancer included in the National Surgical Quality Improvement Program (NSQIP) database

Gandaglia

Varda

Sood

et al. 2014

CUAJ

View full text Add to dashboard Cite

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“…As outlined above, RC is usually a more complex procedure in women. Lee et al [9] analysed 262 consecutive patients (24% women) to confirm this aspect. In this series, the median operative blood loss was 1,400 mL in women compared to 500 mL in men (p = 0.001).…”

Section: Discussionmentioning

confidence: 94%

“…In women, RC is usually a more complex procedure because it commonly involves also the removal of the uterus, fallopian tubes, ovaries, urethra and the anterior vaginal wall [9,10]. Gender-specific discrepancies in the quality of RC have gained considerable interest, as -for instance -higher transfusion and complication rates in women have been reported [9,10].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Gender on Tumour Stage in In-House Complications and Choice of Urinary Diversion: Results of the Austrian Cystectomy Registry

Gschliesser

Eredics²,

Berger³

et al. 2017

Urol Int

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Introduction and Objectives: Bladder cancer is characterized by gender-dependent disparities. To further address this issue, we analysed a prospective, multicentre cystectomy registry. Methods: An online database was developed that included patient demographics, intra/perioperative data, surgical data and in-house complications. Results: Four hundred fifty-eight patients (112 [24.5%] women and 346 [75.5%] men) were analysed. Men and women were comparable regarding age (mean 68 years), body mass index (mean 26.5) and the mean Charlson score (4.8). Women had more advanced tumour-stages (pT3/pT4; women: 57.1%; men: 48.1%). The rate of incontinent urinary diversion was higher in women (83.1%) than in men (60.2%) and in a multivariate analysis, the strongest predictors were M+ status (OR 11.2), female gender (OR 6.9) and age (OR 6.5). Women had a higher intraoperative blood transfusion rate. The overall rate of in-house complications was similar in both genders (men: 32.0%, women: 32.6%). Severe (Clavien-Dindo grade >2) medical (women: 6.3%; men: 5.2%) and surgical (women: 21.5%; men: 14.4%) in-house complications, however, were more frequent in women. Conclusions: This multicentre registry demonstrates several gender-related differences in patients undergoing radical cystectomy. The higher transfusion rate, the rare use of orthotopic bladder substitutes and the higher in-house complication rate underline the higher complexity of this procedure in women.

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“…Although it is reported that RC in the elderly population provides similar disease control and survival outcomes as it does in younger cohorts [9,23], large series of patients are not available. An age over 70 years has been suggested to be a risk factor for higher complication rates [14,25,26,27,28], although it seems proper patient selection here is more important than chronological age alone [27]. …”

Section: Discussionmentioning

confidence: 99%

Comparison of Complications from Radical Cystectomy between Old-Old versus Oldest-Old Patients

Comploj¹,

West

Mian

et al. 2014

Urol Int

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Introduction: The purpose of this study was to evaluate and compare complications after radical cystectomy in patients aged ≥75 years. Materials and Methods: 251 patients aged 75-95 years (median 79) underwent radical cystectomy between 2000 and 2012 at four institutions. The patients were divided into two groups: ≥75-84 years of age (group 1) versus ≥85 years of age (group 2). Comorbidities, body mass index, and complications were obtained retrospectively, except at the Central Hospital of Bolzano and Weill Cornell Medical Center, which collected data prospectively. Cancer-specific survival, overall mortality, hospital stay, clinical outcome and complications were assessed. Complications were categorized using the Clavien-Dindo classification reporting system. The mean follow-up was 21 months. Results: The median hospital stay was 17 (2-91) days. Perioperative Clavien-Dindo grade ≥III complications were seen in 24.1% (48/199) of group 1 patients and 19.2% (10/52) of group 2 patients (p = 0.045). 30- and 90-day mortality was 4.5 and 13.5% in group 1 and 6.5 and 32.3% in group 2, respectively. Only the 90-day mortality rate was statistically significant (p < 0.05) between the two groups. The 3-year overall survival was 40% in group 1 and 34% in group 2. The 3-year cancer-specific survival was 52% in group 1 and 50% in group 2. Conclusions: We evaluated a large series of elderly (≥75 years) patients undergoing radical cystectomy at four institutions. Comparing patients aged ≥75-84 and ≥85 years revealed no significant difference in complications, 30-day mortality, overall and cancer-specific survival rates. Only 90-day mortality rates were significantly higher in the ≥85-year-old patients.

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Gender differences in radical cystectomy: complications and blood loss

Cited by 56 publications

References 13 publications

Short-term perioperative outcomes of patients treated with radical cystectomy for bladder cancer included in the National Surgical Quality Improvement Program (NSQIP) database

Short-term perioperative outcomes of patients treated with radical cystectomy for bladder cancer included in the National Surgical Quality Improvement Program (NSQIP) database

The Impact of Gender on Tumour Stage in In-House Complications and Choice of Urinary Diversion: Results of the Austrian Cystectomy Registry

Comparison of Complications from Radical Cystectomy between Old-Old versus Oldest-Old Patients

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