Complications after robot-assisted radical cystectomy: Results from the international robotic cystectomy consortium

Raza S. Johar, Matthew H. Hayn, Andrew P. Stegemann, Kamran Ahmed, Piyush Agarwal, M. Derya Balbay, Ashok Hemal, Adam S. Kibel, Fred Muhletaler, Kenneth Nepple, John G. Pattaras, James O. Peabody, Joan Palou Redorta, Koon Ho Rha, Lee Richstone, Matthias Saar, Francis Schanne, Douglas S. Scherr, Stefan Siemer, Michael StökleAlon Weizer, Peter Wiklund, Timothy Wilson, Michael Woods, Bertrum Yuh, Khurshid A. Guru

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

Background: Complication reporting is highly variable and nonstandardized. Therefore, it is imperative to determine the surgical outcomes of major oncologic procedures. Objective: To describe the complications after robot-assisted radical cystectomy (RARC) using a standardized and validated reporting methodology. Design, setting, and participants: Using the International Robotic Cystectomy Consortium (IRCC) database, we identified 939 patients who underwent RARC, had available complication data, and had at least 90 d of follow-up. Outcome measurements and statistical analysis: Complications were analyzed and graded according to the Memorial Sloan-Kettering Cancer Center (MSKCC) system and were defined and stratified by organ system. Secondary outcomes included identification of preoperative and intraoperative variables predicting complications. Logistic regression models were used to define predictors of complications and readmission. Results and limitations: Forty-one percent (n = 387) and 48% (n = 448) of patients experienced a complication within 30 and 90 d of surgery, respectively. The highest grade of complication was grade 0 in 52%, grade 1-2 in 29%, and grade 3-5 in 19% patients. Gastrointestinal, infectious, and genitourinary complications were most common (27%, 23%, and 17%, respectively). On multivariable analysis, increasing age group, neoadjuvant chemotherapy, and receipt of blood transfusion were independent predictors of any and high-grade complications, respectively. Thirty and 90-d mortality was 1.3% and 4.2%, respectively. As a multi-institutional database, a disparity in patient selection, operating standards, postoperative management, and reporting of complications can be considered a major limitation of the study. Conclusions: Surgical morbidity after RARC is significant when reported using a standardized reporting methodology. The majority of complications are low grade. Strict reporting of complications is necessary to advocate for radical cystectomy (RC) and helps in patient counseling.

Original languageEnglish
Pages (from-to)52-57
Number of pages6
JournalEuropean Urology
Volume64
Issue number1
DOIs
Publication statusPublished - 2013 Jul 1

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Cystectomy
Robotics
Logistic Models
Databases
Blood Transfusion
Patient Selection
Counseling
Age Groups
Morbidity
Drug Therapy
Mortality
Neoplasms

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Johar, R. S., Hayn, M. H., Stegemann, A. P., Ahmed, K., Agarwal, P., Balbay, M. D., ... Guru, K. A. (2013). Complications after robot-assisted radical cystectomy: Results from the international robotic cystectomy consortium. European Urology, 64(1), 52-57. https://doi.org/10.1016/j.eururo.2013.01.010
Johar, Raza S. ; Hayn, Matthew H. ; Stegemann, Andrew P. ; Ahmed, Kamran ; Agarwal, Piyush ; Balbay, M. Derya ; Hemal, Ashok ; Kibel, Adam S. ; Muhletaler, Fred ; Nepple, Kenneth ; Pattaras, John G. ; Peabody, James O. ; Palou Redorta, Joan ; Rha, Koon Ho ; Richstone, Lee ; Saar, Matthias ; Schanne, Francis ; Scherr, Douglas S. ; Siemer, Stefan ; Stökle, Michael ; Weizer, Alon ; Wiklund, Peter ; Wilson, Timothy ; Woods, Michael ; Yuh, Bertrum ; Guru, Khurshid A. / Complications after robot-assisted radical cystectomy : Results from the international robotic cystectomy consortium. In: European Urology. 2013 ; Vol. 64, No. 1. pp. 52-57.
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abstract = "Background: Complication reporting is highly variable and nonstandardized. Therefore, it is imperative to determine the surgical outcomes of major oncologic procedures. Objective: To describe the complications after robot-assisted radical cystectomy (RARC) using a standardized and validated reporting methodology. Design, setting, and participants: Using the International Robotic Cystectomy Consortium (IRCC) database, we identified 939 patients who underwent RARC, had available complication data, and had at least 90 d of follow-up. Outcome measurements and statistical analysis: Complications were analyzed and graded according to the Memorial Sloan-Kettering Cancer Center (MSKCC) system and were defined and stratified by organ system. Secondary outcomes included identification of preoperative and intraoperative variables predicting complications. Logistic regression models were used to define predictors of complications and readmission. Results and limitations: Forty-one percent (n = 387) and 48{\%} (n = 448) of patients experienced a complication within 30 and 90 d of surgery, respectively. The highest grade of complication was grade 0 in 52{\%}, grade 1-2 in 29{\%}, and grade 3-5 in 19{\%} patients. Gastrointestinal, infectious, and genitourinary complications were most common (27{\%}, 23{\%}, and 17{\%}, respectively). On multivariable analysis, increasing age group, neoadjuvant chemotherapy, and receipt of blood transfusion were independent predictors of any and high-grade complications, respectively. Thirty and 90-d mortality was 1.3{\%} and 4.2{\%}, respectively. As a multi-institutional database, a disparity in patient selection, operating standards, postoperative management, and reporting of complications can be considered a major limitation of the study. Conclusions: Surgical morbidity after RARC is significant when reported using a standardized reporting methodology. The majority of complications are low grade. Strict reporting of complications is necessary to advocate for radical cystectomy (RC) and helps in patient counseling.",
author = "Johar, {Raza S.} and Hayn, {Matthew H.} and Stegemann, {Andrew P.} and Kamran Ahmed and Piyush Agarwal and Balbay, {M. Derya} and Ashok Hemal and Kibel, {Adam S.} and Fred Muhletaler and Kenneth Nepple and Pattaras, {John G.} and Peabody, {James O.} and {Palou Redorta}, Joan and Rha, {Koon Ho} and Lee Richstone and Matthias Saar and Francis Schanne and Scherr, {Douglas S.} and Stefan Siemer and Michael St{\"o}kle and Alon Weizer and Peter Wiklund and Timothy Wilson and Michael Woods and Bertrum Yuh and Guru, {Khurshid A.}",
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Johar, RS, Hayn, MH, Stegemann, AP, Ahmed, K, Agarwal, P, Balbay, MD, Hemal, A, Kibel, AS, Muhletaler, F, Nepple, K, Pattaras, JG, Peabody, JO, Palou Redorta, J, Rha, KH, Richstone, L, Saar, M, Schanne, F, Scherr, DS, Siemer, S, Stökle, M, Weizer, A, Wiklund, P, Wilson, T, Woods, M, Yuh, B & Guru, KA 2013, 'Complications after robot-assisted radical cystectomy: Results from the international robotic cystectomy consortium', European Urology, vol. 64, no. 1, pp. 52-57. https://doi.org/10.1016/j.eururo.2013.01.010

Complications after robot-assisted radical cystectomy : Results from the international robotic cystectomy consortium. / Johar, Raza S.; Hayn, Matthew H.; Stegemann, Andrew P.; Ahmed, Kamran; Agarwal, Piyush; Balbay, M. Derya; Hemal, Ashok; Kibel, Adam S.; Muhletaler, Fred; Nepple, Kenneth; Pattaras, John G.; Peabody, James O.; Palou Redorta, Joan; Rha, Koon Ho; Richstone, Lee; Saar, Matthias; Schanne, Francis; Scherr, Douglas S.; Siemer, Stefan; Stökle, Michael; Weizer, Alon; Wiklund, Peter; Wilson, Timothy; Woods, Michael; Yuh, Bertrum; Guru, Khurshid A.

In: European Urology, Vol. 64, No. 1, 01.07.2013, p. 52-57.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Complications after robot-assisted radical cystectomy

T2 - Results from the international robotic cystectomy consortium

AU - Johar, Raza S.

AU - Hayn, Matthew H.

AU - Stegemann, Andrew P.

AU - Ahmed, Kamran

AU - Agarwal, Piyush

AU - Balbay, M. Derya

AU - Hemal, Ashok

AU - Kibel, Adam S.

AU - Muhletaler, Fred

AU - Nepple, Kenneth

AU - Pattaras, John G.

AU - Peabody, James O.

AU - Palou Redorta, Joan

AU - Rha, Koon Ho

AU - Richstone, Lee

AU - Saar, Matthias

AU - Schanne, Francis

AU - Scherr, Douglas S.

AU - Siemer, Stefan

AU - Stökle, Michael

AU - Weizer, Alon

AU - Wiklund, Peter

AU - Wilson, Timothy

AU - Woods, Michael

AU - Yuh, Bertrum

AU - Guru, Khurshid A.

PY - 2013/7/1

Y1 - 2013/7/1

N2 - Background: Complication reporting is highly variable and nonstandardized. Therefore, it is imperative to determine the surgical outcomes of major oncologic procedures. Objective: To describe the complications after robot-assisted radical cystectomy (RARC) using a standardized and validated reporting methodology. Design, setting, and participants: Using the International Robotic Cystectomy Consortium (IRCC) database, we identified 939 patients who underwent RARC, had available complication data, and had at least 90 d of follow-up. Outcome measurements and statistical analysis: Complications were analyzed and graded according to the Memorial Sloan-Kettering Cancer Center (MSKCC) system and were defined and stratified by organ system. Secondary outcomes included identification of preoperative and intraoperative variables predicting complications. Logistic regression models were used to define predictors of complications and readmission. Results and limitations: Forty-one percent (n = 387) and 48% (n = 448) of patients experienced a complication within 30 and 90 d of surgery, respectively. The highest grade of complication was grade 0 in 52%, grade 1-2 in 29%, and grade 3-5 in 19% patients. Gastrointestinal, infectious, and genitourinary complications were most common (27%, 23%, and 17%, respectively). On multivariable analysis, increasing age group, neoadjuvant chemotherapy, and receipt of blood transfusion were independent predictors of any and high-grade complications, respectively. Thirty and 90-d mortality was 1.3% and 4.2%, respectively. As a multi-institutional database, a disparity in patient selection, operating standards, postoperative management, and reporting of complications can be considered a major limitation of the study. Conclusions: Surgical morbidity after RARC is significant when reported using a standardized reporting methodology. The majority of complications are low grade. Strict reporting of complications is necessary to advocate for radical cystectomy (RC) and helps in patient counseling.

AB - Background: Complication reporting is highly variable and nonstandardized. Therefore, it is imperative to determine the surgical outcomes of major oncologic procedures. Objective: To describe the complications after robot-assisted radical cystectomy (RARC) using a standardized and validated reporting methodology. Design, setting, and participants: Using the International Robotic Cystectomy Consortium (IRCC) database, we identified 939 patients who underwent RARC, had available complication data, and had at least 90 d of follow-up. Outcome measurements and statistical analysis: Complications were analyzed and graded according to the Memorial Sloan-Kettering Cancer Center (MSKCC) system and were defined and stratified by organ system. Secondary outcomes included identification of preoperative and intraoperative variables predicting complications. Logistic regression models were used to define predictors of complications and readmission. Results and limitations: Forty-one percent (n = 387) and 48% (n = 448) of patients experienced a complication within 30 and 90 d of surgery, respectively. The highest grade of complication was grade 0 in 52%, grade 1-2 in 29%, and grade 3-5 in 19% patients. Gastrointestinal, infectious, and genitourinary complications were most common (27%, 23%, and 17%, respectively). On multivariable analysis, increasing age group, neoadjuvant chemotherapy, and receipt of blood transfusion were independent predictors of any and high-grade complications, respectively. Thirty and 90-d mortality was 1.3% and 4.2%, respectively. As a multi-institutional database, a disparity in patient selection, operating standards, postoperative management, and reporting of complications can be considered a major limitation of the study. Conclusions: Surgical morbidity after RARC is significant when reported using a standardized reporting methodology. The majority of complications are low grade. Strict reporting of complications is necessary to advocate for radical cystectomy (RC) and helps in patient counseling.

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