title: Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy.
abstract: OBJECTIVE
  To examine postoperative complications in a contemporary series of patients after radical cystectomy using a standardized reporting system, and to identify readily available preoperative risk factors.
  
  
  METHODS
  Using the modified Clavien-Dindo classification, we assessed the 90-day postoperative clinical course of 535 bladder cancer patients who underwent radical cystectomy and urinary diversion (ileal conduit n = 349, ileal neobladder n = 186) between June 2003 and February 2012 at a single institution. All Martin criteria for standardized reporting of complications were met. Uni- and multivariable analyses for prediction of complications were carried out; covariates included body mass index, Charlson Comorbidity Index, age, sex, American Society of Anesthesiologists Score, neoadjuvant chemotherapy, prior abdominal or pelvic surgery, localized tumor and urinary diversion type.
  
  
  RESULTS
  The 90-day rates for overall (Clavien-Dindo classification I-V) and high-grade complications (Clavien-Dindo classification III-V), as well as mortality (Clavien-Dindo classification V), were 56.4, 18.7 and 3.9%, respectively. Infections (16.4%), bleeding (14.2%) and gastrointestinal complications (10.7%) were the most common adverse outcomes. Independent risk factors for overall complications were body mass index (odds ratio 1.08) and Charlson Comorbidity Index ≥3 (odds ratio 1.93). Risk factors for high-grade complications were Charlson Comorbidity Index ≥3 (odds ratio 1.86), American Society of Anesthesiologists Score ≥3 (odds ratio 1.92) and body mass index (odds ratio 1.07, all P < 0.03).
  
  
  CONCLUSIONS
  Radical cystectomy is associated with significant morbidity; nevertheless, the majority of complications are minor. Charlson Comorbidity Index, American Society of Anesthesiologists Score and body mass index might help to identify patients at risk for high-grade complications after radical cystectomy.
authors.affiliation: Department of Urology, Marienhospital, Ruhr-University Bochum, Herne, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Katharina
authors.initials: K
authors.lastname: Braun
authors.forename: Christian
authors.initials: C
authors.lastname: von Bodman
authors.forename: Marko
authors.initials: M
authors.lastname: Brock
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.forename: Jüri
authors.initials: J
authors.lastname: Palisaar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015897:Comorbidity; D015653:Cystectomy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000401:mortality; D044465:White People
keywords: Clavien; complication; cystectomy; risk factor; urinary diversion