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No. 121. The Christchurch radical c ystectomy d atabase : A critical and prospective a udit , 2007 - 2012. Imran Ali, Peter Davidson, Maria Yamit Department of Urology, Christchurch Hospital, Christchurch, New Zealand. Posters Proudly Supported by: . Results

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No. 121

The Christchurch radical cystectomy database: A critical and prospective audit, 2007 - 2012

Imran Ali, Peter Davidson, Maria Yamit

Department of Urology, Christchurch Hospital, Christchurch, New Zealand

Posters Proudly Supported by:

Results

75 radical cystectomies were performed between 2007 -2012.

Preoperative

There was a 4:1 male to female ratio with a mean age of 68 years. There were 70 European/Pakeha, 4 Maori and 1 Asian patient(s). Their ASA and age-adjusted Charlson score were in the middle range. Themain indication for cystectomy was T2 bladder cancer.

Intraoperative

All procedures were performed in an open manner. Ileal conduit was the predominant reconstruction method.

The mean blood loss was 850ml . 27% of patients were transfused intraoperatively with a mean of 2 units of blood. The mean amount of intraoperative fluid infused (including blood) was 3600ml. The mean surgical time was 234 minutes. These figures were equal to, or better then published data. 1 Most patients had spinal morphine and PCA. The bowel anastomoses were predominantly hand sewn.

Postoperative

The overall complication rate over 90 days was 72% (mainly low grade). Most complications occurred prior to discharge especially major morbidity. 33% of patients had ileus, bowel obstruction or gastric dilatation during their stay. There were 2 deaths. Again these results were comparable to international data.

Patients with a ASA > 2 had a higher Clavien score and those with ileal conduits had a lower Clavien score (p= 0.04). The mean length of stay was 11 days. Double layer bowel anastomosis increased the length of stay as did increasing Clavien score and each unit of blood transfused (p < 0.05).

There was an average cost of $NZ26,000 per patient from admission to discharge. An average of $NZ5,000 was spent on each patient with complications during admission.

The mean follow-up was 34 months. 38% of patients are dead. Clavien and Age-adjusted Charlson scores did not have an impact on survival in this study

Introduction

Radical cystectomy is a high risk, high cost and infrequently performed procedure. Retrospective data from two New Zealand centres had shown high post operative complication rates, however the methods for reporting complications were not standardised. Therefore 5 years ago, a prospective database was set up at Christchurch Hospital to address this.

Aim

The aim of this study was to identify preoperative, intraoperative and postoperative factors that could have an impact on complications which were to be reported using the Clavien classification system. Length of stay and survival were also analysed as well as the costs of the procedure and hospital stay.

  • Methods
  • A prospective database of all radical cystectomies performed from 2007-2012 was maintained.
  • Preoperative, intraoperative and postoperative data was entered.
  • The data was analysed using multiple linear regression.
  • Clavienscore, survival and length of stay were fitted as outcomes of a linear model against various variables.
  • The total costs for each radical cystectomy, from admission to discharge, was obtained.

Conclusions

Overall complication rates are high when using Clavien classification but are comparable to bigger volume centres. ASA score >2 and ileal conduit reconstruction are predictive of complications (higher and lower respectively). Double layer bowel anastomosis, blood transfusion and higher Clavien score were predictive of longer stay.

References

1. Shabsigh, Ahmad, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. European Urology 55.1 (2009): 164-176.

Acknowledgements

John Pearson, Biostatistics Group, Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand.