Experience of surgeon, hospital, and comprehensive cancer team critical to the outcomes of radical cystectomy and urinary diversion

Though radical cystectomy is considered gold standard for muscle-invasive urothelial carcinoma (UC) of the bladder, the operation is fraught with significant perioperative morbidity with a complication rate ranging from 34% to 52% (1,2). Given the nature/biology of the disease, operative time, hospital stay and complication profile, UC is costly from a health services perspective (3). Mossanen et al. investigated the rate and incidence of complications and its effect on perioperative mortality utilizing the Premier Healthcare Database. Despite the limitations of utilizing a population-based hospital discharge database, the authors found that as the number of complications increase, the predicted probability of mortality also increased, especially if patients suffered from ≥4 complications during their index stay (1.0% to 9.7%, P<0.001) (4). Moreover, a complication causing readmission resulted in an increase in the predicted probability of postoperative mortality from 3.9% to 7.4%, P<0.001. Cardiac, pulmonary and renal complications were the most significant predictors of mortality of the 12 categories studied (4). Intuitively, the study confirms the notion that as perioperative or postoperative complications increase, patient outcomes worsen