Complications and Mortality in Paraplegic Patients Undergoing Cystectomy
Author Information
Author(s): Di Bello Francesco MD, Siech Carolin MD, de Angelis Mario MD, Rodriguez Peñaranda Natali MD, Tian Zhe MSc, Goyal Jordan A., Collà Ruvolo Claudia MD, Califano Gianluigi MD, Creta Massimiliano MD, Saad Fred PhD, Shariat Shahrokh F. MD, Briganti Alberto PhD, Chun Felix K. H. MD, Micali Salvatore MD, Longo Nicola MD, Karakiewicz Pierre I. MD
Primary Institution: University of Montréal Health Center, Montréal, QC Canada
Hypothesis
What is the association between paraplegia and perioperative complications as well as in-hospital mortality after radical cystectomy for non-metastatic bladder cancer?
Conclusion
Paraplegic patients have a fourfold higher risk of in-hospital mortality and higher rates of complications after radical cystectomy.
Supporting Evidence
- Paraplegic patients had a higher overall complication rate (76% vs. 60%).
- Paraplegic patients had a higher in-hospital mortality rate (7.0% vs. 1.8%).
- Paraplegic patients were more likely to require critical care therapy (25% vs. 12%).
- Paraplegic patients had a longer median length of stay (10 days vs. 8 days).
- Paraplegic patients were younger and had a higher comorbidity burden.
Takeaway
If someone with paraplegia needs surgery for bladder cancer, they should know there's a much higher chance of serious problems or even dying in the hospital compared to others.
Methodology
The study analyzed discharge data from the National Inpatient Sample (2000–2019) for patients undergoing radical cystectomy.
Potential Biases
Potential selection and reporting biases due to the retrospective nature of the study.
Limitations
The study is retrospective, has selection and reporting biases, and lacks details on surgical timing and expertise.
Participant Demographics
Of the 25,527 patients, 185 (0.7%) were paraplegic, with a median age of 64 years, and a higher proportion of females (28% vs. 19%).
Statistical Information
P-Value
p<0.001
Statistical Significance
p<0.001
Digital Object Identifier (DOI)
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