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Outcomes following radical cystectomy: a population‐based study from Queensland, Australia
Author(s) -
Coughlin Geoffrey D.,
Youl Philippa H.,
Philpot Shoni,
Wright Matthew J.,
Honore Matthew,
Theile David E.
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15259
Subject(s) - medicine , cystectomy , bladder cancer , logistic regression , lymph node , cohort , population , surgery , urology , cancer , environmental health
Background Radical cystectomy (RC) is a complex uro‐oncology surgical procedure with high surgical morbidity. We report on outcomes following RC for bladder cancer using a population‐based cohort of patients. Methods Patients receiving an RC from 2002 to 2016 were included and linked to their cancer‐related surgical procedures. Hospitals were categorized as high (>7 RCs/year) and low (≤7 RCs/year). Outcomes included 30‐ and 90‐day mortalities and 2‐year overall survival (OS). Multivariable logistic regression models were used to examine factors associated with the outcomes of interest. OS was estimated using the Kaplan–Meier survival function. Results During the 15‐year study period, 1230 patients underwent an RC for invasive bladder cancer. In‐hospital mortality was 1.1%, and 30‐ and 90‐day mortality was 1.4% and 2.9%, respectively. Both 30‐ and 90‐day mortalities were significantly higher for older versus younger patients ( P = 0.01 and P < 0.001, respectively), and lymph node involvement was significantly associated with 90‐day mortality ( P = 0.002). Patients treated more recently were about 80% less likely to die within 90 days. The 2‐year OS was 71.5%, with significant improvements observed over time ( P < 0.001). While we found no evidence of a hospital‐volume relationship for post‐operative mortality or survival, patients treated in low‐volume compared to high‐volume hospitals were more likely to have surgical margin involvement (10.9% versus 7.1%, respectively, P = 0.03). Conclusion We observed low post‐operative mortality rates overall, with rates decreasing significantly over time. Some subgroups of patients experience poorer post‐operative outcomes. Reporting on post‐operative outcomes, and survival over time helps monitor clinical progress and identify areas for improvement.