title: Contemporary 90-day mortality rates after radical cystectomy in the elderly.
abstract: BACKGROUND
  Existing radical cystectomy (RC) perioperative mortality estimates may underestimate the contemporary rates due to more advanced age, more baseline comorbidities and potentially broader inclusion criteria for RC, relative to past criteria.
  
  
  METHODS
  Within the most recent Surveillance, Epidemiology, and End Results (SEER)-Medicare database we identified clinically non-metastatic, muscle-invasive (T2-T4a) urothelial carcinoma of the urinary bladder (UCUB) patients, who underwent RC between 1991 and 2009. Mortality at 30- and 90-day after RC was quantified. Multivariable logistic regression analyses tested predictors of 90-day mortality.
  
  
  RESULTS
  Within 5207 assessable RC patients 30- and 90-day mortality rates were 5.2 and 10.6%, respectively. According to age 65-69, 70-79 and ≥ 80 years, 90-day mortality rates were 6.4, 10.1 and 14.8% (p < 0.001). Additionally, 90-day mortality rates increased with increasing Charlson Comorbidity Index (CCI, 0, 1, 2 and ≥ 3): 6.3, 10.3, 12.6 and 15.9% (p < 0.001). 90-day mortality rate in unmarried patients was 13.0 vs. 9.3% in married individuals (p < 0.001). In multivariable logistic regression analyses, advanced age, higher CCI, low socioeconomic status, unmarried status and non organ-confined stage were independent predictors of 90-day mortality (all p < 0.05).
  
  
  CONCLUSIONS
  The contemporary SEER-Medicare derived 90-day mortality rates are substantially higher than previously reported estimates from centers of excellence, and even exceed previous SEER reports. More advanced age, higher CCI score, and other patient characteristics that distinguish the current population from others account for these differences.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: schiffmann@martini-klinik.de.
authors.forename: J
authors.initials: J
authors.lastname: Schiffmann
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Sun
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors.forename: Z
authors.initials: Z
authors.lastname: Tian
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: S F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: M
authors.initials: M
authors.lastname: McCormack
authors.affiliation: Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Valiquette
authors.affiliation: Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Graefen
authors.affiliation: Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Saad
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: P I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D006278:Medicare; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012307:Risk Factors; D018426:SEER Program; D012923:Social Class; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*
keywords: 90-day; Elderly; Perioperative mortality; Predictors; Radical cystectomy; Urothelial carcinoma of the urinary bladder