What should be the patient’s preference regarding the choice of hospital in the case of radical cystectomy? Evaluation of early complications after open radical cystectomy in a medium and high volume setting in one hospital

Figures & data

Table 1 Highest grade complication per patient to Clavien–Dindo classification in the two time periods (A/B) and the subperiod A

CDC score	Definition	1989–2010 (%)	Subgroup: 2005–2010 (%)	2010–2013 (%)
0	No complication observed	39 (13.9)	2 (1.8)	52 (42)
1	Any deviation from normal postoperative course without need for pharmacological treatment (allowed regimens include antiemetics, antipyretics, analgesics, diuretics, electrolytes, physiotherapy, and bedside wound care)	39 (13.9)	17 (15.5)	4 (3)
2	Requiring pharmacological treatment with drugs other than those allowed for grade 1 complications (blood transfusions total parenteral nutrition also included)	104 (37)	38 (34.5)	31 (25)
3a	Requiring surgical, endoscopic, or radiological intervention with pt not under general anesthesia	20 (7)	18 (16.2)	20 (17)
3b	Same as 3a but requiring general anesthesia	64 (22.8)	28 (25.5)	6 (5)
4a	Life-threatening complication requiring intensive care unit management, single organ dysfunction	11 (4)	6 (5.5)	3 (2.5)
4b	Same as 4a but involving multiorgan dysfunction	1 (0.4)	0	4 (3)
5	Death of pt	3 (1)	1 (1)	3 (2.5)
Low grade (1–2)		143 (50.9)	55 (50)	35 (28)
High grade (3–5)		99 (35.2)	53 (48.2)	36 (30)

Notes: One patient can have multiple complications. In this table only the highest and thus most severe complication is documented. Period A, patients who underwent a radical open cystectomy from January 1989 to March 2010; Period B, patients who underwent a radical open cystectomy from April 2010 until December 2013.

Abbreviations: CDC, Clavien–Dindo classification; pt, patient.

Table 2 Basic demographics and operative characteristics in the two time periods (A/B) and the subperiod of A with correlation to the Clavien–Dindo score

Operative characteristics	1989–2010 (period A)	2010–2013 (period B)	Period A vs period B (P-value)	CDC score 1989–2010 vs 2010–2013 (P-value)	Subgroup 2005–2010	2010–2013 (period B)	Subgroup vs period B (P-value)	CDC score 2005–2010 vs 2010–2013 (P-value)
N	281	123			110	123
Sex
Male	228 (81%)	93 (75%)		<0.001	88 (80%)	93 (75%)		0.002
Female	53 (19%)	30 (25%)		0.003	22 (20%)	30 (25%)		0.001
Age			0.010				0.892
<70 years	189 (67%)	66 (54%)		<0.001	60 (54.5%)	66 (54%)		<0.001
>70 years	93 (33%)	57 (46%)		<0.001	50 (45.5%)	57 (46%)		<0.001
ECOG			0.001				0.012
0	65 (23.3%)	28 (22.7%)		0.022	21 (19%)	28 (22.7%)		0.031
1	159 (56.5%)	51 (41.6%)		0.016	66 (60%)	51 (41.6%)		0.024
≥2	57 (20.2%)	44 (35.7%)		0.041	23 (21%)	44 (35.7%)		0.035
No clinical T stage			0.301				0.633
Organ-confined	155 (56%)	61 (49.5%)		<0.001	58 (52.7%)	61 (49.5%)		0.005
Extravesical	126 (44%)	62 (50.5%)		0.006	52 (47.3%)	62 (50.5%)		0.002
No clinical N stage			0.168				0.630
Nx	26 (9.2%)	16 (12.1%)		0.041	11 (10%)	16 (12.1%)		0.06
Negative	177 (62.9%)	66 (53.6%)		<0.001	56 (51%)	66 (53.6%)		<0.001
Positive	78 (27.9%)	42 (34.3%)		<0.001	43 (39%)	42 (34.3%)		0.003
Urinary diversion			0.025				0.149
Ileal conduit	154 (54.8%)	85 (69%)		<0.001	69 (63%)	85 (69%)		<0.001
Continent diversion  (CC and ON)	104 (37%)	32 (27%)		<0.001	28 (25%)	32 (27%)		<0.001
Other	23 (8.6%)	6 (4%)			13 (12%)	6 (4%)

Notes: Period A, patients who underwent a radical open cystectomy from January 1989 to March 2010; Period B, patients who underwent a radical open cystectomy from April 2010 until December 2013.

Abbreviations: CC, continent catheterizable; CDC, Clavien–Dindo classification; ECOG, Eastern Cooperative Oncology Group; ON, orthotopic neobladder; Nx, lymph nodes cannot be evaluated.

Table 3 Intraperiodical analysis of Clavien-Dinado score to operative characteristics

Operative characteristics	1989–2010 (P-value)	2010–2013 (P-value)
Urinary diversion
Ileal conduit vs neobladder	0.002	0.987
Tumor stage
Organ confined vs extravesical	0.711	0.440
ECOG
0–1 vs ≥2	0.024	0.672
Age, years
<70 vs >70	0.008	0.539
Sex
Male vs female	0.801	0.268

Note: P-values obtained using the Kruskal–Wallis test.

Abbreviation: ECOG, Eastern Cooperative Oncology Group.