title: The impact of socioeconomic status on perioperative complications and oncologic outcomes in patients undergoing radical cystectomy.
abstract: OBJECTIVE
  To examine if patients of lower socioeconomic status (SES) are at higher risk of perioperative complications and experience different oncologic outcomes after radical cystectomy (RC).
  
  
  METHODS
  Retrospective review was performed on 383 consecutive non-metastatic patients who underwent definitive RC at a tertiary referral center. Along with clinical and pathologic parameters traditionally utilized for risk stratification, potential social determinants of health were estimated using US Census data. Zip code-derived proxies of SES included median annual household income and percentage of residents completing high school education. Patients were grouped based on SES parameters, and potential differences were assessed. Multivariable logistic regression was then performed to identify predictors of complication within 90 days of RC. Survival outcomes were plotted using Kaplan-Meier survival curves.
  
  
  RESULTS
  Overall, 167 (46.2%) patients suffered any complication within 90 days of RC. On multivariable analysis, length of stay (p ≤ 0.001), lower income grouping (p = 0.03), and lowest education tertile (p = 0.007) were significant predictors of any complication. Income (p = 0.04) and education (p = 0.008) groupings remained significant predictors in a subset analysis looking specifically at post-discharge complications. No significant differences in recurrence-free or overall survival estimates were observed among education (log-rank test: p > 0.9 and p = 0.6, respectively) or income (log-rank test: p = 0.2 and p = 0.09, respectively) groupings.
  
  
  CONCLUSIONS
  Patients of lower socioeconomic status who undergo RC for bladder cancer are at increased risk of perioperative complications. Further studies are needed to clarify this relationship, and to explore interventions aimed to improve outcomes.
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Starr Pavilion, 9th Floor, New York, NY, 10065, USA. dag2042@med.cornell.edu.
authors.forename: David M
authors.initials: DM
authors.lastname: Golombos
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Starr Pavilion, 9th Floor, New York, NY, 10065, USA.
authors.forename: Padraic
authors.initials: P
authors.lastname: O'Malley
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Starr Pavilion, 9th Floor, New York, NY, 10065, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lewicki
authors.affiliation: Department of Urology, Bern University Hospital, Bern, Switzerland.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nguyen
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Starr Pavilion, 9th Floor, New York, NY, 10065, USA.
authors.forename: Benjamin V
authors.initials: BV
authors.lastname: Stone
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Starr Pavilion, 9th Floor, New York, NY, 10065, USA.
authors.forename: Bashir
authors.initials: B
authors.lastname: Al Hussein Al Awamlh
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Starr Pavilion, 9th Floor, New York, NY, 10065, USA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012923:Social Class; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery
keywords: Bladder cancer; Complications; Education; Income; Radical cystectomy; Survival