title: Characterization of perioperative infection risk among patients undergoing radical cystectomy: Results from the national surgical quality improvement program.
abstract: To evaluate the incidence, risk factors, and timing of infections following radical cystectomy (RC).
  
  
  
  The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify patients undergoing RC for bladder cancer from 2006 to 2013. Characteristics including year of surgery, age, sex body mass index, diabetes, smoking, renal function, steroid usage, preoperative albumin, preoperative hematocrit, perioperative blood transfusion (PBT), and operative time were assessed for association with the risk of infection within 30 days of RC using multivariable logistic regression.
  
  
  
  A total of 3,187 patients who had undergone RC were identified, of whom 766 (24.0%) were diagnosed with a postoperative infection, at a median of 13 days (interquartile ranges 8-19) after RC. Infections included surgical site infection (SSI) (404; 12.7%), sepsis/septic shock (405; 12.7%), and urinary tract infection (UTI) (309; 9.7%). On multivariable analysis, body mass index≥30kg/m2(odds ratios [OR] = 1.52; P<0.01), receipt of a PBT (OR = 1.27; P<0.01), and operative time≥480 minutes (OR = 1.72; P<0.01) were significantly associated with the risk of infection. When the outcomes of UTI, SSI, and sepsis were analyzed separately, operative time≥480 minutes remained independently associated with increased infection risk in each model (OR = 2.11 for UTI, OR = 1.63 for SSI, and OR = 1.80 for sepsis/septic shock; all P<0.05), whereas PBT was associated with SSI and sepsis/septic shock (OR = 1.33 and OR = 1.29, respectively; both P< 0.05).
  
  
  
  Approximately 25% of patients undergoing RC experience an infection within 30 days of surgery. Several potentially modifiable risk factors for infection were identified, specifically PBT and prolonged operative time, which may represent opportunities for future care improvement.
authors: Department of Urology, Mayo Clinic, Rochester, MN.
authors: William P
authors: WP
authors: Parker
authors: Department of Urology, Mayo Clinic, Rochester, MN.
authors: Matthew K
authors: MK
authors: Tollefson
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors: Courtney N
authors: CN
authors: Heins
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors: Kristine T
authors: KT
authors: Hanson
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors: Elizabeth B
authors: EB
authors: Habermann
authors: Department of Urology, Mayo Clinic, Rochester, MN.
authors: Harras B
authors: HB
authors: Zaid
authors: Department of Urology, Mayo Clinic, Rochester, MN.
authors: Igor
authors: I
authors: Frank
authors: Department of Urology, Mayo Clinic, Rochester, MN.
authors: R Houston
authors: RH
authors: Thompson
authors: Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: Boorjian.stephen@mayo.edu.
authors: Stephen A
authors: SA
authors: Boorjian
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D015653:Cystectomy; D066264:Datasets as Topic / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement / Q000458:organization & administration*; D012306:Risk; D012772:Shock, Septic / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000601:surgery*; D014552:Urinary Tract Infections / Q000453:epidemiology
keywords: Bladder cancer; Infection; NSQIP; Radical cystectomy; Risk factors; Urinary diversion