title: Risk of in-hospital complications after radical cystectomy for urinary bladder carcinoma: population-based follow-up study of 7608 patients.
abstract: OBJECTIVE
  To evaluate the risk of different in-hospital complications for patients undergoing a radical cystectomy (RC), as limited nationwide population data on short- and long-term complications after RC is available, despite it being the standard treatment for localised muscle-invasive urinary bladder cancer (UBC).
  
  
  METHODS
  In all, 7608 persons underwent a RC after UBC diagnosis, as registered in the Swedish National Patient Register between 1964 and 2008. We estimated the frequency and incidences and calculated hazard ratios (HR) and 95% confidence intervals (CI) using multivariate Cox proportional hazards models.
  
  
  RESULTS
  Urinary tract infection/septicaemia was the most common complication following radical cystectomy, with an incidence of 90.4 per 1,000 person years. There was a higher risk of urinary tract infection among patients who had a continent cutaneous reservoir (HR: 1.11 (0.94-1.30) or orthotopic neobladder 1.21 (1.05-1.39) than among those with ileal conduit. Similarly, continent cutaneous reservoir and orthotopic neobladder were associated with increased risks for wound and abdominal wall hernias, stones in the urinary tract, hydronephrosis and nephrostomy tube treatment, and kidney failure. In contrast, risk of bowel obstruction was lower among those with orthotopic neobladder than those with ileal conduit (HR: 0.64 (0.50-0.81)) and those with continent cutaneous reservoir (HR: 0.92 (0.73-1.16).
  
  
  CONCLUSIONS
  In-hospital complications after RC are numerous and continue to accumulate for many years after surgery, indicating the need for life-long follow-up of these patients. Comparison between different types of diversion should, however, be made with care because of potential confounding by indication.
authors.affiliation: Division of Cancer Studies, Cancer Epidemiology Group, School of Medicine, King's College London, London, UK.
authors.forename: Mieke
authors.initials: M
authors.lastname: van Hemelrijck
authors.forename: Andreas
authors.initials: A
authors.lastname: Thorstenson
authors.forename: Philip
authors.initials: P
authors.lastname: Smith
authors.forename: Jan
authors.initials: J
authors.lastname: Adolfsson
authors.forename: Olof
authors.initials: O
authors.lastname: Akre
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D016016:Proportional Hazards Models; D053018:Pyonephrosis / Q000453:epidemiology / Q000209:etiology; D011788:Quality of Life; D012042:Registries; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects*; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology
keywords: bladder cancer; complication; cystectomy
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