Presentation Authors: Jakob Klemm, Michael Rink, Philipp Gild, Florian Janisch, Armin Soave, Roland Dahlem, Margit Fisch, Malte W. Vetterlein*, Hamburg, Germany
Introduction: Given the lack of individual patient data addressing the timing of perioperative complications following major urological procedures, we aimed to provide granular time-to-event data for short-term adverse events following radical cystectomy (RC).
Methods: We performed a meticulous digital chart review of patients undergoing RC between 2009-2017 at our institution. The updated EAU criteria of standardized reporting were met and we extracted and tabulated 30-day complications of each patient according to a predefined complication catalogue. Complications were ranked by the Clavien-Dindo classification (CDC) and the exact time interval from RC to each complication was calculated. We evaluated traditional morbidity endpoints and categorized complications according to the Memorial Sloan Kettering Cancer Center complication groups. Time-to-event analyses followed two steps: Firstly, we plotted the time to complication (in days) for each complication group to assess the chronological distribution of complication categories over the first 30 days after RC. Secondly, we evaluated whether timing of major complications (â‰¥CDC grade IIIa) differed when patients were stratified according to the CDC. Box-and-whisker diagrams were used as a visualization tool to depict time-to-event data.
Results: Of 506 patients, 503 (99%) experienced a total of 2 485 short-term complications, of which the most common were genitourinary (24%), gastrointestinal (19%), and infectious (15%) complications. The timing of complication incidence across the different groups was very heterogeneous (Figure 1A).Overall, major complications (â‰¥CDC grade IIIa) occurred in 78 patients (15%), translating into 23 (4.6%), 31 (6.1%), 12 (2.4%), and 12 (2.4%) patients suffering from a maximum CDC grade IIIa, IIIb, IVa, and V complication, respectively. Median time to major complications was 10 days (IQR 4-15). With exception of patients who died within 30 days of surgery (CDC grade V), median time to complication decreased with higher CDC grades (Figure 1B).
Conclusions: Knowledge of the timing of adverse events is important to facilitate anticipation and informed discussion regarding expectations of the postoperative course. Further identification of risk factors may guide in improving patient-tailored care.