title: Complications after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium.
abstract: BACKGROUND
  Complication reporting is highly variable and nonstandardized. Therefore, it is imperative to determine the surgical outcomes of major oncologic procedures.
  
  
  OBJECTIVE
  To describe the complications after robot-assisted radical cystectomy (RARC) using a standardized and validated reporting methodology.
  
  
  METHODS
  Using the International Robotic Cystectomy Consortium (IRCC) database, we identified 939 patients who underwent RARC, had available complication data, and had at least 90 d of follow-up.
  
  
  METHODS
  Complications were analyzed and graded according to the Memorial Sloan-Kettering Cancer Center (MSKCC) system and were defined and stratified by organ system. Secondary outcomes included identification of preoperative and intraoperative variables predicting complications. Logistic regression models were used to define predictors of complications and readmission.
  
  
  CONCLUSIONS
  Forty-one percent (n=387) and 48% (n=448) of patients experienced a complication within 30 and 90 d of surgery, respectively. The highest grade of complication was grade 0 in 52%, grade 1-2 in 29%, and grade 3-5 in 19% patients. Gastrointestinal, infectious, and genitourinary complications were most common (27%, 23%, and 17%, respectively). On multivariable analysis, increasing age group, neoadjuvant chemotherapy, and receipt of blood transfusion were independent predictors of any and high-grade complications, respectively. Thirty and 90-d mortality was 1.3% and 4.2%, respectively. As a multi-institutional database, a disparity in patient selection, operating standards, postoperative management, and reporting of complications can be considered a major limitation of the study.
  
  
  CONCLUSIONS
  Surgical morbidity after RARC is significant when reported using a standardized reporting methodology. The majority of complications are low grade. Strict reporting of complications is necessary to advocate for radical cystectomy (RC) and helps in patient counseling.
authors: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors: Raza S
authors: RS
authors: Johar
authors: Matthew H
authors: MH
authors: Hayn
authors: Andrew P
authors: AP
authors: Stegemann
authors: Kamran
authors: K
authors: Ahmed
authors: Piyush
authors: P
authors: Agarwal
authors: M Derya
authors: MD
authors: Balbay
authors: Ashok
authors: A
authors: Hemal
authors: Adam S
authors: AS
authors: Kibel
authors: Fred
authors: F
authors: Muhletaler
authors: Kenneth
authors: K
authors: Nepple
authors: John G
authors: JG
authors: Pattaras
authors: James O
authors: JO
authors: Peabody
authors: Joan
authors: J
authors: Palou Redorta
authors: Koon-Ho
authors: KH
authors: Rha
authors: Lee
authors: L
authors: Richstone
authors: Matthias
authors: M
authors: Saar
authors: Francis
authors: F
authors: Schanne
authors: Douglas S
authors: DS
authors: Scherr
authors: Stefan
authors: S
authors: Siemer
authors: Michael
authors: M
authors: Stökle
authors: Alon
authors: A
authors: Weizer
authors: Peter
authors: P
authors: Wiklund
authors: Timothy
authors: T
authors: Wilson
authors: Michael
authors: M
authors: Woods
authors: Bertrum
authors: B
authors: Yuh
authors: Khurshid A
authors: KA
authors: Guru
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001208:Asia; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005060:Europe; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012107:Research Design / Q000592:standards; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D012720:Severity of Illness Index; D025321:Surgery, Computer-Assisted / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*