A Cystectomy Risk Calculator and Assessment Based on NSQIP Data

ABSTRACT Background: The American Cancer Society estimates that 72,570 people will be diagnosed with bladder cancer and 15,210 people will die from the disease in 2013. Radical cystectomy has been the standard treatment for decades, but the procedure is associated with significant morbidity and mortality. Currently, there are no preoperative tools which can help assess patient postoperative risk. In this study, we address this need by creating a cystectomy risk calculator based on analysis of data from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP). Methods: The NSQIP database was queried for cystectomy cases for bladder cancer between 2005 and 2011. Fifty preoperative patient parameters and 74 postoperative outcomes were assessed, but only 32 independent preoperative variables had adequate sample size and were included in the stepwise logistic regression models for overall mortality and morbidity. Statistically significant variables were weighed and used to create a cystectomy risk calculator. Results: From the NSQIP database, 1095 cystectomy cases were identified. High preoperative BUN levels and previous PCI were predictive for increased postop morbidity risk. Previous cardiac surgery was associated with lower postop morbidity risk. Chemotherapy treatment within 30 days of surgery was associated with lower postop morbidity risk but increased postop mortality risk. Chronic steroid treatment and high preoperative WBC lab values were also associated with increased postop mortality risk. Conclusion: This study identifies significant predictive preoperative variables that inform postoperative complications following cystectomy. The cystectomy risk calculator created gives physicians and patients a more precise estimation of individual risks of morbidity and mortality associated with the procedure.Master of Public Healt