title: Age, American Society of Anesthesiologists physical status classification and Charlson score are independent predictors of 90-day mortality after radical cystectomy.
abstract: OBJECTIVE
  Radical cystectomy (RC) is a major surgical procedure accompanied with meaningful complications and countable perioperative mortality. To identify the risk factors predicting the perioperative morbidity and mortality is essential. The study aimed to identify relevant, patient-specific factors associated with 90-day mortality following RC, which may serve as a foundation for improving healthcare delivery to patients with bladder cancer.
  
  
  METHODS
  We investigated a sample of 1015 consecutive patients in order to identify predictors of 90-day mortality after RC. Beside tumor-related parameters, ASA classification, NYHA, Canadian Cardiovascular Society classification of angina pectoris, Charlson score, age, gender and the single conditions contributing to the Charlson score were included in the multivariable analyses. The patient data were collected retrospectively, except the ASA score that was obtained prospectively.
  
  
  RESULTS
  We identified a model containing the parameters age (OR 1.05, p = 0.023), ASA classification of 3-4 (OR 6.19, p < 0.001) and Charlson score (OR 1.22, p = 0.003) to predict 90-day mortality. Among the single conditions to the Charlson score, moderate or severe renal disease (OR 3.94, p < 0.001) and liver disease (OR 3.24, p = 0.037) were most closely related to 90-day mortality.
  
  
  CONCLUSIONS
  Age, ASA classification and Charlson score as well as moderate or severe renal disease and liver disease appear to be independent predictors of 90-day mortality after RC. Given the highly significant association of ASA score with 90-day mortality and the relative ease and width disposability of this measure, this classification should be, after external validation, incorporated into daily clinical practice in treatment of patients planned to RC.
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. Vladimir.Novotny@uniklinikum-dresden.de.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Novotny
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Froehner
authors.affiliation: Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Koch
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zastrow
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Heberling
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Leike
authors.affiliation: Department of Anesthesiology, University Hospital "Carl Gustav Carus", Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hübler
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Manfred P
authors.initials: MP
authors.lastname: Wirth
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology; D015653:Cystectomy; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012955:Societies, Medical; D013997:Time Factors; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000145:classification / Q000150:complications / Q000601:surgery*
keywords: ASA classification; Age; Bladder cancer; Comorbidity; Mortality; Radical cystectomy