title: The effect of preoperative clinical variables on the 30- and 90-day morbidity and mortality after radical cystectomy: A single-centre study.
abstract: OBJECTIVE
  To analyse the effect of preoperative clinical variables and comorbidity on the early, late and cumulative 90-day morbidity and mortality rates, as well as hospital re-admissions, after radical cystectomy (RC), in one centre.
  
  
  METHODS
  All patients undergoing RC over a period of 3 months were included. Preoperative investigations included measurements of serum albumin, a complete blood analysis, body mass index (BMI), Charlson comorbidity index (CCI) and the age-adjusted CCI (ACCI). We recorded the length of hospital stay (LOS) and all postoperative events for 90 days, and graded them according to the five-grade modification of the original Clavien system.
  
  
  RESULTS
  In all there were 31 patients undergoing RC (mean age 58.4 years). The mean preoperative serum albumin and haemoglobin level, BMI, CCI and ACCI were 3.82 g/dL, 12.53 g/dL, 29.29 kg/m(2), 3.0 and 4.58, respectively. The mean LOS was 20.03 days; seven patients needed re-admission and three died within the 90 days. There were postoperative complications in 20 patients. The age, CCI and ACCI were significantly associated with complications (P = 0.009, 0.001 and < 0.001, respectively). Preoperative haemoglobin, BMI and smoking had no effect on the morbidity or mortality rate. The LOS increased in older patients (P = 0.031) and those with a higher ACCI (P = 0.042). Postoperative mortality increased among patients with a lower serum albumin level (P = 0.048).
  
  
  CONCLUSIONS
  Age, CCI and ACCI are related to early postoperative complications. Older patients and patients with a higher ACCI have a longer LOS. A low preoperative albumin level needs to be evaluated more thoroughly.
authors.affiliation: Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Khaled
authors.initials: K
authors.lastname: Mursi
authors.affiliation: Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Hany
authors.initials: H
authors.lastname: ElFayoumy
authors.affiliation: Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Ismail
authors.initials: I
authors.lastname: Saad
authors.affiliation: Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Tawakol
authors.affiliation: Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Hesham
authors.initials: H
authors.lastname: Badawy
keywords: ACCI, age-adjusted CCI; BMI, body mass index; Bladder cancer; CCI, charlson comorbidity index; Charlson index; Comorbidity; Complications; Cystectomy; Hb, haemoglobin; IQR, interquartile range; LOS, length of hospital stay; RC, radical cystectomy