title: Variability in complications and operative mortality after radical cystectomy in Spain.
abstract: BACKGROUND
  In the literature, mortality for radical cystectomy (RC) varies between 2.3% and 7.5%. In Spain, there are no published general data on morbidity and mortality.
  
  
  OBJECTIVE
  To identify the complications and mortality of RC in Spain through an analysis of all procedures performed over a 3-year period and to study the geographic variability of these results.
  
  
  METHODS
  We identified patients who underwent RC in the Spanish National Health System between 2011 and 2013 based on the minimum basic data set. We analysed the complications and mortality during hospitalisation and at 30, 60 and 90 days. We compared these results in the various autonomous communities, adjusted them by age, Charlson score and sex and subsequently added the hospital size.
  
  
  RESULTS
  We studied 7999 patients who underwent RC in 197 hospitals of the Spanish National Health System. The mean age of the series was 67.2±9.8 years. The median stay was 15 days (IQR, 11-24). Some 47.2% of the patients had complications. The mean mortality in-hospital and at 30, 60 and 90 days was 4.7, 2.9, 5 and 6.2%, respectively. There was considerable variability in the mortality at 90 days among the communities (3.8-9.1%). When adjusting by the patient and hospital characteristics, there were still significant geographic variations (3.8-11.5%).
  
  
  CONCLUSIONS
  RC mortality in Spain at 90 days is similar to the rate in the literature. There are significant geographic variations unexplained by the characteristics of the patients or by those of the hospitals in which these operations were performed.
authors.affiliation: Servicio de Urología y Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), España. Electronic address: cllorente@fhalcorcon.es.
authors.forename: C
authors.initials: C
authors.lastname: Llorente
authors.affiliation: Servicio de Urología y Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), España.
authors.forename: B
authors.initials: B
authors.lastname: López
authors.affiliation: Servicio de Urología y Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), España.
authors.forename: V
authors.initials: V
authors.lastname: Hernández
authors.affiliation: Servicio de Urología y Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), España.
authors.forename: A
authors.initials: A
authors.lastname: Guijarro
authors.affiliation: Servicio de Urología y Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), España.
authors.forename: E
authors.initials: E
authors.lastname: Pérez-Fernández
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery*
keywords: Bladder cancer; Cistectomía radical; Conjunto mínimo básico de datos; Cáncer de vejiga; Minimum basic data set; Morbidity; Morbilidad; Mortalidad; Mortality; Radical cystectomy