Defining the association between the prolonged operative time and 90-day complications in patients undergoing radical cystectomy

doi:10.1016/j.ajur.2023.04.004

Asian Journal of Urology, 2024, 11 (3): 429-436 doi: 10.1016/j.ajur.2023.04.004

Regular Papers: Original Articles

Defining the association between the prolonged operative time and 90-day complications in patients undergoing radical cystectomy

Peter Hanna^a,b,*(

),Joseph Zabell^a,Badrinath Konety^c,Christopher Warlick^a

^aDepartment of Urology, University of Minnesota, Minneapolis, MN, USA
^bDepartment of Urology, Aswan University, Aswan, Egypt
^cDepartment of Urology, Rush University, Chicago, IL, USA

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Abstract

Objective: Radical cystectomy is a complex lengthy procedure associated with postoperative morbidity. We aimed to assess the operative time (OT) in patients undergoing radical cystectomy and its impact on 90-day postoperative complications and readmission rates.

Methods: The retrospective cohort study included 296 patients undergoing radical cystectomy and urinary diversion from May 2010 to December 2018 in our institution. The OT of 369 min was set as a cutoff value between short and long OT groups. The primary outcome was 90-day postoperative complication rates. Secondary outcomes were gastrointestinal recovery time, length of hospital stay, and 90-day readmission rates.

Results: The overall incidence of 90-day postoperative complications was 79.7% where 43.2% representing low-grade complications according to the Clavien-Dindo classification (Grade 1 and Grade 2), and 36.5% representing high-grade complications (Grade≥3). Gastrointestinal tract and infectious complications are the most common complications in our data set (45.9% and 45.6%, respectively). On multivariable analysis, prolonged OT was significantly associated with odds of high-grade complications (odds ratio 2.340, 95% confidence interval 1.288-4.250, p=0.005). After propensity score-matched analysis, a higher incidence of major complications was identified in the long OT group 55 (51.4%) compared to 35 (32.7%) in the short OT group (p=0.006). A shorter gastrointestinal tract recovery time was noticed in the short OT group (p=0.009). Prolonged OT was associated with a higher 90-day readmission rate on univariate and multivariate analyses (p<0.001, p=0.001, respectively).

Conclusion: Prolonged OT (>369 min) is associated with an increased risk of postoperative complications and readmission rates. The perception of potential postoperative complications requires careful monitoring of these patients which could translate into better operative outcomes.

Key words： Radical cystectomy Operative time Complication Readmission

Received: 13 November 2022 Available online: 20 July 2024

Corresponding Authors: *Department of Urology, University of Minnesota, Minneapolis, MN, USA. E-mail address: phannah@umn.edu (P. Hanna).

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Cite this article:

Peter Hanna,Joseph Zabell,Badrinath Konety, et al. Defining the association between the prolonged operative time and 90-day complications in patients undergoing radical cystectomy[J]. Asian Journal of Urology, 2024, 11(3): 429-436.

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http://www.ajurology.com/EN/10.1016/j.ajur.2023.04.004 OR http://www.ajurology.com/EN/Y2024/V11/I3/429

Demographic criteria for patients (n=296).

The receiver operating characteristic curve of operative time and postoperative complications to predict the cutoff value of the operative time yielding the highest area under the curve value associated with severe postoperative complications (369 min). Diagonal segments were produced by ties.

Postoperative outcomes (n=296).

Multivariable logistic regression for postoperative complications (low grade or high grade) and the incidence of 90-day readmission rates.

Forest plot showing multivariate analysis of potential risk factors of major postoperative complications. Odds ratios are shown with 95% confidence intervals for the age, sex, smoking, BMI, CCI, operative approach, operative time (369 min as the cutoff value), EBL, surgical experience, type of diversion, and ERAS as possible predictors for development of postoperative complications. BMI, body mass index; CCI, Charlson Comorbidity Index; EBL, estimated blood loss; ERAS, enhanced recovery after surgery protocol.

Postoperative outcomes between matched groups based on operative time after propensity score-matched analysis.

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