Perioperative complications and in-hospital mortality in radical cystectomy patients with heart-valve replacement

Carolin Siech; Andrea Baudo; Mario de Angelis; Letizia Maria Ippolita Jannello; Francesco Di Bello; Jordan A Goyal; Zhe Tian; Fred Saad; Shahrokh F Shariat; Nicola Longo; Luca Carmignani; Ottavio de Cobelli; Alberto Briganti; Marina Kosiba; Philipp Mandel; Luis A Kluth; Felix K H Chun; Pierre I Karakiewicz

doi:10.1016/j.ejso.2024.108297

Perioperative complications and in-hospital mortality in radical cystectomy patients with heart-valve replacement

Eur J Surg Oncol. 2024 Mar 28;50(6):108297. doi: 10.1016/j.ejso.2024.108297. Online ahead of print.

Authors

Carolin Siech¹, Andrea Baudo², Mario de Angelis³, Letizia Maria Ippolita Jannello⁴, Francesco Di Bello⁵, Jordan A Goyal⁶, Zhe Tian⁶, Fred Saad⁶, Shahrokh F Shariat⁷, Nicola Longo⁸, Luca Carmignani⁹, Ottavio de Cobelli¹⁰, Alberto Briganti¹¹, Marina Kosiba¹², Philipp Mandel¹², Luis A Kluth¹², Felix K H Chun¹², Pierre I Karakiewicz⁶

Affiliations

¹ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany. Electronic address: siech@med.uni-frankfurt.de.
² Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Donato, Milan, Italy.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
⁴ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
⁵ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
⁶ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁷ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
⁸ Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
⁹ Department of Urology, IRCCS Policlinico San Donato, Milan, Italy; Department of Urology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy.
¹⁰ Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy; Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy.
¹¹ Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
¹² Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany.

PMID: 38581754
DOI: 10.1016/j.ejso.2024.108297

Abstract

Purpose: To assess in-hospital mortality and complication rates after radical cystectomy (RC) in patients with history of heart-valve replacement.

Materials and methods: Using the National Inpatient Sample (2000-2019), non-metastatic bladder cancer patients undergoing RC were stratified according to history of heart-valve replacement. Regression models (RM) predicted hospital outcomes.

Results: Of 25,535 RC patients, 250 (1.0%) harbored history of heart-valve replacement. Heart-valve replacement patients were older (median 74 vs. 70 years), more frequently male (87.2 vs. 80.6%), and more frequently had Charlson comorbidity index ≥3 (26.8 vs. 18.9%). In RC patients with history of heart-valve replacement vs. others, 62 vs. 2634 (24.8 vs. 10.4%) experienced cardiac complications, 28 vs. 3092 (11.2 vs. 12.2%) intraoperative complications, 11 vs. 1046 (4.4 vs. 4.1%) infections, <11 vs. 594 (<4.4 vs. 2.3%) perioperative bleeding, <11 vs. 699 (<4.4 vs. 2.8%) vascular complications, 74 vs. 6225 (29.6 vs. 24.7%) received blood transfusions, 37 vs. 3054 (14.8 vs. 12.1%) critical care therapy (CCT), and in-hospital mortality was recorded in <11 vs. 463 (<4.4 vs. 1.8%) patients. In multivariable RM, history of heart-valve replacement independently predicted cardiac complications (odds ratio 2.20, 95% confidence interval 1.62-2.99; p < 0.001). Conversely, no statically significant association was recorded between history of heart-valve replacement and length of stay, estimated hospital cost, intraoperative complications, perioperative bleeding, vascular complications, infections, blood transfusions, CCT use, and in-hospital mortality.

Conclusions: Radical cystectomy patients with history of heart-valve replacement exhibited a 2.2-fold higher risk of cardiac complications, but no other complications, including no significantly higher in-hospital mortality.

Keywords: Bladder cancer; Comorbidity; Heart surgery; Heart-valve replacement; NIS.