Perioperative Outcomes following Neoadjuvant Chemotherapy and Radical Cystectomy-Is There Room for Improvement?

Neil Pugashetti, Thenappan Chandrasekar, Robert Lurvey, Blythe Durbin-Johnson, Marc Dall'Era, Ralph W deVere White, Christopher P Evans, Stanley Yap

Research output: Contribution to journal › Article

1 Citation (Scopus)

Abstract

Introduction: We identify the impact of neoadjuvant chemotherapy before open radical cystectomy on perioperative outcomes and identify actionable areas for improvement. Methods: The impact of neoadjuvant chemotherapy on perioperative outcomes after radical cystectomy for muscle invasive bladder cancer from 2003 to 2014 was assessed using an institutional database. Individual outcomes (venous thromboembolism, surgical site infection, cardiac event) and a composite score using the Clavien-Dindo classification were identified. Univariable and multivariable logistic regression models were used to identify predictors of perioperative complication and 30-day readmission rates. Results: A total of 241 patients were included in the study, of whom 175 underwent radical cystectomy alone (72.6%) and 66 were treated with neoadjuvant chemotherapy plus radical cystectomy (27.4%). The 30-day readmission rate for the neoadjuvant chemotherapy cohort was 30.5% compared to 17.2% for radical cystectomy alone. Multivariable logistic regression analysis identified neoadjuvant chemotherapy as an independent predictor of 30-day readmission (OR 3.47, p=0.01). Of the patients on neoadjuvant chemotherapy readmitted within 30 days 72.2% were readmitted with infections. All other outcomes were not significantly associated with neoadjuvant chemotherapy. Conclusions: While the administration of neoadjuvant chemotherapy did not significantly increase perioperative complications, patients receiving neoadjuvant chemotherapy had an increased rate of 30-day readmission, with infection being the most common etiology. This increased readmission rate has not been previously identified in this patient population to our knowledge and is an important focus for quality improvement.

Original languageEnglish (US)
JournalUrology Practice
DOIs
StateAccepted/In press - 2016

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Cystectomy
Drug Therapy
Logistic Models
Surgical Wound Infection
Venous Thromboembolism
Quality Improvement
Infection
Urinary Bladder Neoplasms
Regression Analysis
Databases
Muscles

Keywords

  • Neoadjuvant therapy
  • Perioperative period
  • Treatment outcome
  • Urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Perioperative Outcomes following Neoadjuvant Chemotherapy and Radical Cystectomy-Is There Room for Improvement? / Pugashetti, Neil; Chandrasekar, Thenappan; Lurvey, Robert; Durbin-Johnson, Blythe; Dall'Era, Marc; deVere White, Ralph W; Evans, Christopher P; Yap, Stanley.

In: Urology Practice, 2016.

Research output: Contribution to journal › Article

Pugashetti, N, Chandrasekar, T, Lurvey, R, Durbin-Johnson, B, Dall'Era, M, deVere White, RW, Evans, CP & Yap, S 2016, 'Perioperative Outcomes following Neoadjuvant Chemotherapy and Radical Cystectomy-Is There Room for Improvement?', Urology Practice. https://doi.org/10.1016/j.urpr.2015.09.004
Pugashetti N, Chandrasekar T, Lurvey R, Durbin-Johnson B, Dall'Era M, deVere White RW et al. Perioperative Outcomes following Neoadjuvant Chemotherapy and Radical Cystectomy-Is There Room for Improvement? Urology Practice. 2016. https://doi.org/10.1016/j.urpr.2015.09.004
Pugashetti, Neil ; Chandrasekar, Thenappan ; Lurvey, Robert ; Durbin-Johnson, Blythe ; Dall'Era, Marc ; deVere White, Ralph W ; Evans, Christopher P ; Yap, Stanley. / Perioperative Outcomes following Neoadjuvant Chemotherapy and Radical Cystectomy-Is There Room for Improvement?. In: Urology Practice. 2016.
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abstract = "Introduction: We identify the impact of neoadjuvant chemotherapy before open radical cystectomy on perioperative outcomes and identify actionable areas for improvement. Methods: The impact of neoadjuvant chemotherapy on perioperative outcomes after radical cystectomy for muscle invasive bladder cancer from 2003 to 2014 was assessed using an institutional database. Individual outcomes (venous thromboembolism, surgical site infection, cardiac event) and a composite score using the Clavien-Dindo classification were identified. Univariable and multivariable logistic regression models were used to identify predictors of perioperative complication and 30-day readmission rates. Results: A total of 241 patients were included in the study, of whom 175 underwent radical cystectomy alone (72.6{\%}) and 66 were treated with neoadjuvant chemotherapy plus radical cystectomy (27.4{\%}). The 30-day readmission rate for the neoadjuvant chemotherapy cohort was 30.5{\%} compared to 17.2{\%} for radical cystectomy alone. Multivariable logistic regression analysis identified neoadjuvant chemotherapy as an independent predictor of 30-day readmission (OR 3.47, p=0.01). Of the patients on neoadjuvant chemotherapy readmitted within 30 days 72.2{\%} were readmitted with infections. All other outcomes were not significantly associated with neoadjuvant chemotherapy. Conclusions: While the administration of neoadjuvant chemotherapy did not significantly increase perioperative complications, patients receiving neoadjuvant chemotherapy had an increased rate of 30-day readmission, with infection being the most common etiology. This increased readmission rate has not been previously identified in this patient population to our knowledge and is an important focus for quality improvement.",
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AU - Dall'Era, Marc

AU - deVere White, Ralph W

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N2 - Introduction: We identify the impact of neoadjuvant chemotherapy before open radical cystectomy on perioperative outcomes and identify actionable areas for improvement. Methods: The impact of neoadjuvant chemotherapy on perioperative outcomes after radical cystectomy for muscle invasive bladder cancer from 2003 to 2014 was assessed using an institutional database. Individual outcomes (venous thromboembolism, surgical site infection, cardiac event) and a composite score using the Clavien-Dindo classification were identified. Univariable and multivariable logistic regression models were used to identify predictors of perioperative complication and 30-day readmission rates. Results: A total of 241 patients were included in the study, of whom 175 underwent radical cystectomy alone (72.6%) and 66 were treated with neoadjuvant chemotherapy plus radical cystectomy (27.4%). The 30-day readmission rate for the neoadjuvant chemotherapy cohort was 30.5% compared to 17.2% for radical cystectomy alone. Multivariable logistic regression analysis identified neoadjuvant chemotherapy as an independent predictor of 30-day readmission (OR 3.47, p=0.01). Of the patients on neoadjuvant chemotherapy readmitted within 30 days 72.2% were readmitted with infections. All other outcomes were not significantly associated with neoadjuvant chemotherapy. Conclusions: While the administration of neoadjuvant chemotherapy did not significantly increase perioperative complications, patients receiving neoadjuvant chemotherapy had an increased rate of 30-day readmission, with infection being the most common etiology. This increased readmission rate has not been previously identified in this patient population to our knowledge and is an important focus for quality improvement.

AB - Introduction: We identify the impact of neoadjuvant chemotherapy before open radical cystectomy on perioperative outcomes and identify actionable areas for improvement. Methods: The impact of neoadjuvant chemotherapy on perioperative outcomes after radical cystectomy for muscle invasive bladder cancer from 2003 to 2014 was assessed using an institutional database. Individual outcomes (venous thromboembolism, surgical site infection, cardiac event) and a composite score using the Clavien-Dindo classification were identified. Univariable and multivariable logistic regression models were used to identify predictors of perioperative complication and 30-day readmission rates. Results: A total of 241 patients were included in the study, of whom 175 underwent radical cystectomy alone (72.6%) and 66 were treated with neoadjuvant chemotherapy plus radical cystectomy (27.4%). The 30-day readmission rate for the neoadjuvant chemotherapy cohort was 30.5% compared to 17.2% for radical cystectomy alone. Multivariable logistic regression analysis identified neoadjuvant chemotherapy as an independent predictor of 30-day readmission (OR 3.47, p=0.01). Of the patients on neoadjuvant chemotherapy readmitted within 30 days 72.2% were readmitted with infections. All other outcomes were not significantly associated with neoadjuvant chemotherapy. Conclusions: While the administration of neoadjuvant chemotherapy did not significantly increase perioperative complications, patients receiving neoadjuvant chemotherapy had an increased rate of 30-day readmission, with infection being the most common etiology. This increased readmission rate has not been previously identified in this patient population to our knowledge and is an important focus for quality improvement.

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