title: Analysis of gender differences in early perioperative complications following radical cystectomy at a tertiary cancer center using a standardized reporting methodology.
abstract: OBJECTIVE
  Gender differences in perioperative complications following radical cystectomy (RC) are under-studied, but suggest a tendency for higher blood loss and/or transfusion in females. Variability in reporting methodologies may affect findings; therefore, we utilized a standardized reporting methodology to evaluate for gender differences in perioperative complications at a tertiary cancer center.
  
  
  METHODS
  A retrospective review of the Memorial Sloan-Kettering Cancer Center (MSKCC) RC database between 1995 and 2005 was performed. All complications within 90 days of surgery were recorded and classified using a 5-grade modification of the Clavien system.
  
  
  RESULTS
  Of 1,142 study patients, 280 (25%) were female. Preoperatively, females were more likely to have multiple co-morbidities (39% vs. 27%, P < 0.001), a prior abdominal surgery (64% vs. 42%, P < 0.001), and to be slightly less obese than men. Females had longer operative times (mean 413 vs. 391 minutes; P = 0.005), higher blood loss (mean 1,322 cc vs. 1,151 cc, P = 0.002), and higher transfusion rates (>4 units red blood cells: 13% vs. 8%; P = 0.025). Although females were significantly more likely than males to experience a complication within 90 days of surgery (72% vs. 62%; P = 0.003); we did not find any important differences in the rate, grade, type, or timing of complications between genders. Additionally, females were less likely than males to receive a continent diversion (25% vs. 40%, P < 0.001) or a pelvic lymph node dissection (90% vs. 96%, P < 0.001).
  
  
  CONCLUSIONS
  Females in our cohort had significantly higher blood loss, more transfusions, and a higher rate of complications. Females were also less likely to undergo a node dissection or continent diversion, for reasons not totally attributable to patient or disease characteristics, implying patient or surgeon preference played a role.
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer, New York, NY 10021, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Siegrist
authors.forename: Caroline
authors.initials: C
authors.lastname: Savage
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shabsigh
authors.forename: Angel
authors.initials: A
authors.lastname: Cronin
authors.forename: S Machele
authors.initials: SM
authors.lastname: Donat
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D017678:Sex Distribution; D012737:Sex Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*