Evaluation of risk factors for perioperative complications after radical cystectomy

Older age and comorbidities are associated with increased perioperative risks and mortality. The mean age of the patients who underwent radical cystectomy (RC) continues to increase. The aim of study was to evaluate the relationship between the rate of perioperative complications, age and comorbidities in patients who undergo RC. A retrospective analysis of 144 patients who underwent RC due to muscle-invasive bladder cancer between January 1st, 2016 and December 31st, 2019 in Riga East University Hospital, Urology and Urologic Oncology Center was performed. The comorbidities of the patients were assessed according to American Society of Anesthesiology (ASA) classification and Charlson Comorbidity Index (CCI). 125 (86,8%) males and 19 (13,2%) females were included in the study. The mean age was 67,9 ± 8,7 (35-86) years, median age - 69,0 years. Intrahospital mortality (30-day mortality) was 6,9%(10 patients) and 90-day mortality was 12,5%(18 patients). Postoperative complications were observed in 84(58,3%) cases. Comparing age groups >75 years and <75 years there was 4-fold increase in intrahospital mortality (6 patients(15%) vs. 4(3,8%), p=0,018) and 3-fold increase in 90-day mortality (10 patients(25%) vs. 8(7,7%), p=0,009) in age group >75 years. There was 10-fold (7 patients(25,0%) vs. 3(2,6%), p=0,000) and 5-fold (10 patients(35,7%) vs. 8(6,9%), p=0,000) increase in intrahospital and 90-day mortality accordingly in patients with CCI<50% compared to patients with CCI>50%. Comparing groups by the ASA score there was 3-fold increase in intrahospital mortality (10 patients(10,9%) vs. 0(0%), p=0,014) and 5-fold increase in 90-day mortality (16 patients(17,4%) vs. 2(3,8%), p=0,019) in the group ASA≥3. In the group CCI<50% there was approximately 1,5-fold increase in the rate of intraoperative complications compared to group CCI>50% (23 patients(82,1%) vs. 61(52,6%), p=0,005). Increased patient’s age, ASA score un CCI is associated with increased complication rate and mortality. Summary comorbidity measures should be used in patient selection for surgery.