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

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology Pub Date : 2024-07-01 DOI:10.1016/j.ajur.2023.04.004

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引用次数: 0

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.

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确定根治性膀胱切除术患者手术时间延长与90天并发症的关系

目的根治性膀胱切除术是一种复杂而漫长的手术，术后发病率高。我们旨在评估接受根治性膀胱切除术患者的手术时间（OT）及其对术后 90 天并发症和再入院率的影响。方法回顾性队列研究纳入了 2010 年 5 月至 2018 年 12 月在我院接受根治性膀胱切除术和尿路改道术的 296 例患者。将369分钟的OT设定为短OT组和长OT组之间的分界值。主要结果是术后90天并发症发生率。结果术后90天并发症的总发生率为79.7%，其中43.2%为Clavien-Dindo分类的低级并发症（1级和2级），36.5%为高级并发症（≥3级）。在我们的数据集中，胃肠道并发症和感染性并发症是最常见的并发症（分别占 45.9% 和 45.6%）。在多变量分析中，长时间加时与高级别并发症的几率显著相关（几率比 2.340，95% 置信区间 1.288-4.250，P=0.005）。经过倾向评分匹配分析，发现长时间加时治疗组的主要并发症发生率为 55（51.4%），而短时间加时治疗组为 35（32.7%）（P=0.006）。短期加时治疗组的胃肠道恢复时间更短（P=0.009）。在单变量和多变量分析中，加时过长与较高的 90 天再入院率相关（分别为 p<0.001 和 p=0.001）。对潜在术后并发症的感知要求对这些患者进行仔细监测，从而获得更好的手术效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Asian Journal of Urology UROLOGY & NEPHROLOGY-

CiteScore

4.00

自引率

3.80%

发文量

100

审稿时长

4 weeks

期刊介绍： Asian Journal of Urology (AJUR), launched in October 2014, is an international peer-reviewed Open Access journal jointly founded by Shanghai Association for Science and Technology (SAST) and Second Military Medical University (SMMU). AJUR aims to build a communication platform for international researchers to effectively share scholarly achievements. It focuses on all specialties of urology both scientifically and clinically, with article types widely covering editorials, opinions, perspectives, reviews and mini-reviews, original articles, cases reports, rapid communications, and letters, etc. Fields of particular interest to the journal including, but not limited to: • Surgical oncology • Endourology • Calculi • Female urology • Erectile dysfunction • Infertility • Pediatric urology • Renal transplantation • Reconstructive surgery • Radiology • Pathology • Neurourology.