Radical cystectomy (RC) is a complex procedure requiring the urinary system’s reconstruction. Reported rates of perioperative complications range from 27% to 73%, and operative time also varies widely according to factors such as patient age, tumor stage, need for lysis of adhesions, and type of urinary diversion.
Lorine Haeuser, MD, Matthew Mossanen, MD, MPH, urologic surgeons in the Division of Urology at Brigham and Women’s Hospital, and colleagues have published evidence that RC lasting four to four years five hours may reflect the best balance of efficiency and meticulousness. In Urologia Internationalis, they also report higher complication rates after both extremely short and extremely long RC procedures.
The researchers used the National Surgical Quality Improvement Program (NSQIP) database of the American College of Surgeons to identify 10,548 patients who underwent RC for any reason between 2011 and 2017. They excluded 28 patients whose operative time was reported as <60 minutes, leaving 10,520 patients for analysis.
Postoperative complications are recorded in the NSQIP database according to the Clavien–Dindo Classification (CDC):
- CDC I—Any deviation from the postoperative course
- CDC II—Complications requiring pharmacological treatment
- CDC III—Reintervention
- CDC IV—Life-threatening complication/ICU admission
- CDC V—Death
The team defined major complications as CDC ≥3.
The key findings were:
- 55% of patients had a complication in any CDC class, and 18% had a major complication
- The proportion of patients with any complication was 47% when RC lasted 2.5 hours and 70% when the operative time was >10 hours
- The probability of major complications was similar when RC lasted between 60 minutes and 4.5 hours
- Beyond 4.5 hours, the odds of a major complication were 1.15 times higher for each additional hour (P<0.001)
- The rate of major complications was lowest, 15%, at 4.5 hours, whereas it was 17.5% at 2.5 hours and 28% at >10 hours
Although operative time is multifactorial, its duration may be useful for predicting postoperative outcomes.