Perioperative Complications and Mortality in Patients with Urothelial Carcinoma and End-Stage Renal Disease Undergoing One-Stage Complete Urinary Tract Extirpation

Yun Ching Huang, Ying Hsu Chang, Alan W. Shindel, Yin Lun Chang, Jian Hui Lin, Dong Ru Ho, Chih Shou Chen

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Complete urinary tract extirpation (CUTE) is a complex procedure with substantial risk for perioperative complications. The association between clinical characteristics and the risk of major postoperative complications has not been systematically investigated. Objective: The aim of this study was to analyze the incidence and risks for major perioperative complications after CUTE. Methods: Respective chart review of 81 patients with urothelial carcinoma (UC) who were treated with one-stage CUTE between January 2004 and December 2015. Fisher’s exact test with Chi square and two-tailed t test were used in categorical and continuous variables, respectively. Univariable and multivariable logistic regression models were used to evaluate the probability of major complications. Results: In this population, 53 (65.4%) patients had Clavien grade 0–2 complications (‘no major complications’) and 28 (34.6%) patients had Clavien grade 3–5 complications (‘major complications’). Compared with the major complications group, patients in the no major complications group were younger, had lower Charlson Comorbidity Index (CCI), higher preoperative serum albumin, and shorter duration of hospitalization (p < 0.05 for all). Major complications were more common in low-volume surgeons (p = 0.002). On multivariate logistic regression analyses, CCI ≥ 5 (odds ratio [OR] 6.25, 95% confidence interval [CI] 1.42–27.47; p = 0.015) and surgery by a provider who performed three or fewer cases during the study interval (OR 13.4, 95% CI 2.20–80.89; p = 0.005) were independent predictors for major complications. Conclusions: High CCI should alert providers to increased probability of major complications, and warrant vigilant management after CUTE. Surgeon volume was inversely related to major postoperative complications.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Nov 14 2017

Fingerprint

Urinary Tract
Chronic Kidney Failure
Carcinoma
Comorbidity
Mortality
Logistic Models
Odds Ratio
Confidence Intervals
Chi-Square Distribution
Serum Albumin
Hospitalization
Regression Analysis
Incidence
Population
Surgeons

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Perioperative Complications and Mortality in Patients with Urothelial Carcinoma and End-Stage Renal Disease Undergoing One-Stage Complete Urinary Tract Extirpation. / Huang, Yun Ching; Chang, Ying Hsu; Shindel, Alan W.; Chang, Yin Lun; Lin, Jian Hui; Ho, Dong Ru; Chen, Chih Shou.

In: Annals of Surgical Oncology, 14.11.2017, p. 1-9.

Research output: Contribution to journalArticle

@article{49c12501397041a199058545bb0b859f,
title = "Perioperative Complications and Mortality in Patients with Urothelial Carcinoma and End-Stage Renal Disease Undergoing One-Stage Complete Urinary Tract Extirpation",
abstract = "Background: Complete urinary tract extirpation (CUTE) is a complex procedure with substantial risk for perioperative complications. The association between clinical characteristics and the risk of major postoperative complications has not been systematically investigated. Objective: The aim of this study was to analyze the incidence and risks for major perioperative complications after CUTE. Methods: Respective chart review of 81 patients with urothelial carcinoma (UC) who were treated with one-stage CUTE between January 2004 and December 2015. Fisher’s exact test with Chi square and two-tailed t test were used in categorical and continuous variables, respectively. Univariable and multivariable logistic regression models were used to evaluate the probability of major complications. Results: In this population, 53 (65.4{\%}) patients had Clavien grade 0–2 complications (‘no major complications’) and 28 (34.6{\%}) patients had Clavien grade 3–5 complications (‘major complications’). Compared with the major complications group, patients in the no major complications group were younger, had lower Charlson Comorbidity Index (CCI), higher preoperative serum albumin, and shorter duration of hospitalization (p < 0.05 for all). Major complications were more common in low-volume surgeons (p = 0.002). On multivariate logistic regression analyses, CCI ≥ 5 (odds ratio [OR] 6.25, 95{\%} confidence interval [CI] 1.42–27.47; p = 0.015) and surgery by a provider who performed three or fewer cases during the study interval (OR 13.4, 95{\%} CI 2.20–80.89; p = 0.005) were independent predictors for major complications. Conclusions: High CCI should alert providers to increased probability of major complications, and warrant vigilant management after CUTE. Surgeon volume was inversely related to major postoperative complications.",
author = "Huang, {Yun Ching} and Chang, {Ying Hsu} and Shindel, {Alan W.} and Chang, {Yin Lun} and Lin, {Jian Hui} and Ho, {Dong Ru} and Chen, {Chih Shou}",
year = "2017",
month = "11",
day = "14",
doi = "10.1245/s10434-017-6251-2",
language = "English (US)",
pages = "1--9",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",

}

TY - JOUR

T1 - Perioperative Complications and Mortality in Patients with Urothelial Carcinoma and End-Stage Renal Disease Undergoing One-Stage Complete Urinary Tract Extirpation

AU - Huang, Yun Ching

AU - Chang, Ying Hsu

AU - Shindel, Alan W.

AU - Chang, Yin Lun

AU - Lin, Jian Hui

AU - Ho, Dong Ru

AU - Chen, Chih Shou

PY - 2017/11/14

Y1 - 2017/11/14

N2 - Background: Complete urinary tract extirpation (CUTE) is a complex procedure with substantial risk for perioperative complications. The association between clinical characteristics and the risk of major postoperative complications has not been systematically investigated. Objective: The aim of this study was to analyze the incidence and risks for major perioperative complications after CUTE. Methods: Respective chart review of 81 patients with urothelial carcinoma (UC) who were treated with one-stage CUTE between January 2004 and December 2015. Fisher’s exact test with Chi square and two-tailed t test were used in categorical and continuous variables, respectively. Univariable and multivariable logistic regression models were used to evaluate the probability of major complications. Results: In this population, 53 (65.4%) patients had Clavien grade 0–2 complications (‘no major complications’) and 28 (34.6%) patients had Clavien grade 3–5 complications (‘major complications’). Compared with the major complications group, patients in the no major complications group were younger, had lower Charlson Comorbidity Index (CCI), higher preoperative serum albumin, and shorter duration of hospitalization (p < 0.05 for all). Major complications were more common in low-volume surgeons (p = 0.002). On multivariate logistic regression analyses, CCI ≥ 5 (odds ratio [OR] 6.25, 95% confidence interval [CI] 1.42–27.47; p = 0.015) and surgery by a provider who performed three or fewer cases during the study interval (OR 13.4, 95% CI 2.20–80.89; p = 0.005) were independent predictors for major complications. Conclusions: High CCI should alert providers to increased probability of major complications, and warrant vigilant management after CUTE. Surgeon volume was inversely related to major postoperative complications.

AB - Background: Complete urinary tract extirpation (CUTE) is a complex procedure with substantial risk for perioperative complications. The association between clinical characteristics and the risk of major postoperative complications has not been systematically investigated. Objective: The aim of this study was to analyze the incidence and risks for major perioperative complications after CUTE. Methods: Respective chart review of 81 patients with urothelial carcinoma (UC) who were treated with one-stage CUTE between January 2004 and December 2015. Fisher’s exact test with Chi square and two-tailed t test were used in categorical and continuous variables, respectively. Univariable and multivariable logistic regression models were used to evaluate the probability of major complications. Results: In this population, 53 (65.4%) patients had Clavien grade 0–2 complications (‘no major complications’) and 28 (34.6%) patients had Clavien grade 3–5 complications (‘major complications’). Compared with the major complications group, patients in the no major complications group were younger, had lower Charlson Comorbidity Index (CCI), higher preoperative serum albumin, and shorter duration of hospitalization (p < 0.05 for all). Major complications were more common in low-volume surgeons (p = 0.002). On multivariate logistic regression analyses, CCI ≥ 5 (odds ratio [OR] 6.25, 95% confidence interval [CI] 1.42–27.47; p = 0.015) and surgery by a provider who performed three or fewer cases during the study interval (OR 13.4, 95% CI 2.20–80.89; p = 0.005) were independent predictors for major complications. Conclusions: High CCI should alert providers to increased probability of major complications, and warrant vigilant management after CUTE. Surgeon volume was inversely related to major postoperative complications.

UR - http://www.scopus.com/inward/record.url?scp=85033685852&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85033685852&partnerID=8YFLogxK

U2 - 10.1245/s10434-017-6251-2

DO - 10.1245/s10434-017-6251-2

M3 - Article

C2 - 29139021

AN - SCOPUS:85033685852

SP - 1

EP - 9

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

ER -