Outcomes following radical cystectomy: a population-based study from Queensland, Australia.
BACKGROUND
Radical cystectomy (RC) is a complex uro-oncology surgical procedure with high surgical morbidity. We report on outcomes following RC for bladder cancer using a population-based cohort of patients.


METHODS
Patients receiving an RC from 2002 to 2016 were included and linked to their cancer-related surgical procedures. Hospitals were categorized as high (>7 RCs/year) and low (≤7 RCs/year). Outcomes included 30- and 90-day mortalities and 2-year overall survival (OS). Multivariable logistic regression models were used to examine factors associated with the outcomes of interest. OS was estimated using the Kaplan-Meier survival function.


RESULTS
During the 15-year study period, 1230 patients underwent an RC for invasive bladder cancer. In-hospital mortality was 1.1%, and 30- and 90-day mortality was 1.4% and 2.9%, respectively. Both 30- and 90-day mortalities were significantly higher for older versus younger patients (P = 0.01 and P < 0.001, respectively), and lymph node involvement was significantly associated with 90-day mortality (P = 0.002). Patients treated more recently were about 80% less likely to die within 90 days. The 2-year OS was 71.5%, with significant improvements observed over time (P < 0.001). While we found no evidence of a hospital-volume relationship for post-operative mortality or survival, patients treated in low-volume compared to high-volume hospitals were more likely to have surgical margin involvement (10.9% versus 7.1%, respectively, P = 0.03).


CONCLUSION
We observed low post-operative mortality rates overall, with rates decreasing significantly over time. Some subgroups of patients experience poorer post-operative outcomes. Reporting on post-operative outcomes, and survival over time helps monitor clinical progress and identify areas for improvement.
['Coughlin|Geoffrey D|GD|', 'Youl|Philippa H|PH|https://orcid.org/0000-0001-6318-5741', 'Philpot|Shoni|S|', 'Wright|Matthew J|MJ|', 'Honore|Matthew|M|https://orcid.org/0000-0003-0114-122X', 'Theile|David E|DE|', '|||']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D015331:Cohort Studies D015653:Cystectomy D005260:Female D017052:Hospital Mortality D006801:Humans D008297:Male D008875:Middle Aged D011793:Queensland D012189:Retrospective Studies D015996:Survival Rate D016896:Treatment Outcome D001749:Urinary Bladder Neoplasms
radical cystectomy population-based bladder cancer mortality