title: 90-Day Mortality after Radical Cystectomy for Bladder Cancer: Prognostic Factors in a Multicenter Case Series.
abstract: OBJECTIVE
  To identify preoperative risk factors for 90-day mortality and to validate existing nomograms in a multicenter series of patients undergoing radical cystectomy (RC).
  
  
  METHODS
  We evaluated 90-day mortality in 475 patients following RC and urinary diversion at 2 Italian institutions and validated Aziz and Isbarn nomogram. Univariable logistic models assessed the predictive ability of operative volume, age at intervention, gender, body mass index, carcinoma in situ at transurethral resection of the bladder, American Society of Anesthesiologist (ASA) score, Charlson Comorbidity Index, clinical stage and pathological stage (TNM).
  
  
  RESULTS
  Of the total number of patients, 387 of them (81%) were male. The median age at RC was 71.8. The most frequent ASA score was 2 (53%). Twenty-five deaths occurred within 90 days (5.3%), all among patients who had undergone RC and incontinent urinary diversion. Risk was higher in patients with advanced disease (OR 2.4); moreover, 90-day mortality odd in 70-79-year-old patients was 13 times higher than those of younger patients (<70). Predictive accuracy using Isbarn's and Aziz's nomogram were 67 and 71%, respectively.
  
  
  CONCLUSIONS
  Our multicenter study confirmed the moderate predictive value of the Aziz nomogram. Larger studies are needed to improve on existing nomograms with the aim of enhancing preoperative counseling.
authors.affiliation: Department of Urology, Bolzano General Hospital, Bolzano, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: D'Elia
authors.forename: Evi
authors.initials: E
authors.lastname: Comploj
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Cerruto
authors.forename: Emanuela
authors.initials: E
authors.lastname: Trenti
authors.forename: Salvatore Mario
authors.initials: SM
authors.lastname: Palermo
authors.forename: Roberto
authors.initials: R
authors.lastname: Melotti
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011183:Postoperative Complications; D011379:Prognosis; D012044:Regression Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery*; D014547:Urinary Diversion