Hospitalization before surgery and subsequent risk of infective complications after radical cystectomy: A population-based analysis

TY - JOUR

T1 - Hospitalization before surgery and subsequent risk of infective complications after radical cystectomy: A population-based analysis

AU - Zaffuto, Emanuele

AU - Pompe, Raisa

AU - Bondarenko, Helen Davis

AU - Moschini, Marco

AU - Dell'Oglio, Paolo

AU - Gandaglia, Giorgio

AU - Fossati, Nicola

AU - Shariat, Shahrokh F

AU - Montorsi, Francesco

AU - Briganti, Alberto

AU - Karakiewicz, Pierre I

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2017/11

Y1 - 2017/11

N2 - INTRODUCTION: The length of stay prior to surgery increases the risk of postoperative infections (PIs) in several surgical settings, such as cardiac, orthopedic, and general surgery. However, data for urological oncology procedures are limited. We examined PI rates after radical cystectomy (RC) according to the length of stay prior to RC (LOSPRC).MATERIALS AND METHODS: A total of 24,242 patients with bladder cancer treated with RC between 1998 and 2013 were abstracted from the National Inpatients Sample database. We evaluated changes over time in LOSPRC (0 vs. 1 vs. 2 days or more) and tested its effect on PI rates. Multivariable logistic regression analyses were adjusted for the year of surgery, sex, age, ethnicity, comorbidities, hospital location, teaching status, hospital surgical volume, and number of hospital beds.RESULTS: Overall, 19,401 (80.0%), 3,990 (16.5%), and 851 (3.5%) individuals with LOSPRC of 0, 1. and 2 or more were identified. The proportion of LOSPRC 0 patients increased from 61.4% in 1998 to 91.0% in 2013 (P<0.001), whereas the opposite trend was observed for LOSPRC 1 and 2 or more. In multivariable logistic regression analyses predicting PIs, LOSPRC of 1 (odds ratio: 1.38; 95% CI: 1.25-1.53; P<0.001) and LOSPRC of 2 or more (odds ratio: 2.15; 95% CI: 1.81-2.55; P<0.001) achieved independent predictor status.CONCLUSIONS: A delay in surgery as short as 1 day significantly increases the risk of PIs after RC. In consequence, same day of admission surgery policies should be further promoted to reduce the risk of PIs.

AB - INTRODUCTION: The length of stay prior to surgery increases the risk of postoperative infections (PIs) in several surgical settings, such as cardiac, orthopedic, and general surgery. However, data for urological oncology procedures are limited. We examined PI rates after radical cystectomy (RC) according to the length of stay prior to RC (LOSPRC).MATERIALS AND METHODS: A total of 24,242 patients with bladder cancer treated with RC between 1998 and 2013 were abstracted from the National Inpatients Sample database. We evaluated changes over time in LOSPRC (0 vs. 1 vs. 2 days or more) and tested its effect on PI rates. Multivariable logistic regression analyses were adjusted for the year of surgery, sex, age, ethnicity, comorbidities, hospital location, teaching status, hospital surgical volume, and number of hospital beds.RESULTS: Overall, 19,401 (80.0%), 3,990 (16.5%), and 851 (3.5%) individuals with LOSPRC of 0, 1. and 2 or more were identified. The proportion of LOSPRC 0 patients increased from 61.4% in 1998 to 91.0% in 2013 (P<0.001), whereas the opposite trend was observed for LOSPRC 1 and 2 or more. In multivariable logistic regression analyses predicting PIs, LOSPRC of 1 (odds ratio: 1.38; 95% CI: 1.25-1.53; P<0.001) and LOSPRC of 2 or more (odds ratio: 2.15; 95% CI: 1.81-2.55; P<0.001) achieved independent predictor status.CONCLUSIONS: A delay in surgery as short as 1 day significantly increases the risk of PIs after RC. In consequence, same day of admission surgery policies should be further promoted to reduce the risk of PIs.

KW - Journal Article

U2 - 10.1016/j.urolonc.2017.07.004

DO - 10.1016/j.urolonc.2017.07.004

M3 - SCORING: Journal article

C2 - 28755960

VL - 35

SP - 659.e7-659.e12

JO - UROL ONCOL-SEMIN ORI

JF - UROL ONCOL-SEMIN ORI

SN - 1078-1439

IS - 11

ER -