title: Perioperative complications and mortality after radical cystectomy when using a standardized reporting methodology.
abstract: OBJECTIVE
  To evaluate, by using a standardized reporting methodology, the perioperative complications and mortality in patients who underwent radical cystectomy.
  
  
  METHODS
  We retrospectively reviewed all data of 404 consecutive patients who underwent radical cystectomy from 1995 to 2009 for nonmetastatic bladder cancer at the same academic center. Perioperative complications and perioperative mortality were defined as any adverse event or death from any cause within 90 days of surgery. All perioperative complications were reported according to the Martin criteria and were graded according to the Clavien system (grade 1-5). Univariate and multivariate analyses for the clinical and pathologic characteristics were used to evaluate predictors of complications.
  
  
  RESULTS
  A total of 296 complications occurred in 209 (51.7%) patients. Among them, 139 (34.4% of the entire population) had only a '"minor"' (grade 1-2) complication, whereas 70 (17.3%) had a "major" (grade 3-5) complication. Eighteen (4.5%) patients died within 90 days after surgery. At univariate analysis, age ≥75 years (2P = .018), serum creatinine level ≥1.4 mg/dL (2P = .025), American Society of Anesthesiologists (ASA) score of 3 to 4 (2P < .001) were significant predictors of complications after 30 days from surgery; conversely, the ASA score was the only significant predictor of complications after 90 days. At multivariate analysis, only the ASA score was independently correlated with the development of complications at 30 and 90 days of follow-up (2P < .001).
  
  
  CONCLUSIONS
  Radical cystectomy is one of the most complex procedures in urology, with a high rate of complications and mortality. The use of a standardized methodology is the only way to estimate the actual rate and the severity of complications.
authors: Department of Urology, University of Bologna, Bologna, Italy. rschiavina@yahoo.it
authors: Riccardo
authors: R
authors: Schiavina
authors: Marco
authors: M
authors: Borghesi
authors: Mascia
authors: M
authors: Guidi
authors: Valerio
authors: V
authors: Vagnoni
authors: Ziv
authors: Z
authors: Zukerman
authors: Cristian
authors: C
authors: Pultrone
authors: Giovanni
authors: G
authors: Passaretti
authors: Daniele
authors: D
authors: Romagnoli
authors: Lorenzo
authors: L
authors: Bianchi
authors: Antonio
authors: A
authors: Morselli-Labate
authors: Eugenio
authors: E
authors: Brunocilla
authors: Marco
authors: M
authors: Garofalo
authors: Fabio
authors: F
authors: Manferrari
authors: Sergio
authors: S
authors: Concetti
authors: Giuseppe
authors: G
authors: Martorana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003404:Creatinine / Q000097:blood; D015653:Cystectomy / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*
chemical_list: D003404:Creatinine