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PD12-09 CHARACTERIZATION OF INFECTION RISK AFTER RADICAL CYSTECTOMY: RESULTS FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM
THE JOURNAL OF UROLOGYâ
e296
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
requiring further intervention, which may help to identify which patients need more aggressive monitoring for potential failures.
Source of Funding: None
PD12-09 CHARACTERIZATION OF INFECTION RISK AFTER RADICAL CYSTECTOMY: RESULTS FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM William Parker*, Matthew Tollefson, Courtney Heins, Kristine Hanson, Elizabeth Habermann, Harras Zaid, Igor Frank, R. Houston Thompson, Stephen Boorjian, Rochester, MN INTRODUCTION AND OBJECTIVES: Radical cystectomy (RC) represents the standard of care for muscle-invasive and high-risk non-muscle invasive bladder cancer. However, RC is associated with a high complication rate, including perioperative infection. In addition to causing patient morbidity, infections have been identified as a quality metric. Herein, we evaluated the incidence, risk factors, and timing of infection following RC. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify patients undergoing RC for bladder cancer from 2005-2013 using CPT procedure and ICD-9 diagnosis codes. Characteristics including age, gender, body-mass index (BMI), diabetes, smoking status, renal function, steroid usage, albumin, perioperative blood transfusion (PBT), and operative time were assessed for their independent association with the risk of infection (inclusive of urinary tract infection (UTI), surgical site infection (SSI), and sepsis) within 30 days of RC using multivariable logistic regression. RESULTS: A total of 3,187 patients were identified, of whom 2,604 (81.8%) were male. Median age was 70 years (IQR 62, 77). Infection within 30 days of RC was diagnosed in 766 (24%) patients, at a median of 13 days (IQR 8, 19) after RC. The most common infections were SSI (404; 12.7%) and sepsis (405; 12.7%), followed by UTI (309; 9.7%). On multivariable analysis (Table), factors significantly associated with an increased risk of postoperative infection were BMI 30 (OR 1.52; p<0.01), receipt of a PBT (OR 1.28; p<0.01), and operative time 480 min (OR 1.69; p<0.01). When the outcomes of UTI, SSI, and sepsis were analyzed separately, operative time 480 min remained independently associated with increased infection risk in each model (OR 2.07 for UTI, OR 1.62 for SSI, and OR 1.74 for sepsis; all p<0.05), while PBT was associated with SSI and sepsis (OR 1.31 and OR 1.35, respectively; both p<0.05). CONCLUSIONS: Approximately 25% of patients undergoing RC experience an infection within 30 days of surgery. Several potentially modifiable risk factors for infection were identified, specifically PBT and prolonged operative time, which represent potential targets for care improvement.
Source of Funding: None
PD12-10 CASE DURATION AND PERIOPERATIVE HYPOTENSION ARE ASSOCIATED WITH GREATER INCIDENCE OF HIGH GRADE COMPLICATIONS IN PATIENTS WHO UNDERGO URINARY DIVERSION FOR BENIGN INDICATIONS Yahir Santiago-Lastra*, Michael R. Mathis, Elizabeth Andraska, Aleda M. L. Thompson, Bahaa S. Malaeb, Anne P. Cameron, J. Quentin Clemens, John T. Stoffel, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: We report the 90-day complications, long-term survival, and perioperative variables associated with greater severity of complications in patients undergoing open urinary diversion (UD) for benign indications. METHODS: We retrospectively reviewed patients who underwent UD for benign indications at a tertiary referral center (2007-2014). Demographic, perioperative, and postoperative variables were extracted. Patients were classified to their most severe complication within 90 days of surgery using the Clavien-Dindo system. Multivariable analysis was performed for variables associated with high-grade complications. Survival data was obtained from the Federal Social Security Death Master File and the State Death Index. RESULTS: 141 patients were included in the analysis. Demographics results are summarized in Table 1. Patients who had a prolonged mean arterial pressure (MAP) below 75% of baseline at any point during the intraoperative period were 10.0 times as likely to have a class III+ complication (95% CI 1.13 to 88.48; p ¼ 0.038) within 90 days. In addition, every 1-minute increase in operative time above the median of 343 minutes increased the odds of a class III+ complication by 1% (95% CI 1.00 to 1.01; p ¼ 0.006). Finally, those who had continuing vasopressor requirement immediately postoperatively (defined as vasopressor infusion occurring in the recovery area) were 5.7 times as likely to have a class III+ complication (95% CI 1.24 to 25.78; p ¼ 0.025). Age, low functional status, increased BMI, history of radiation and high-risk neurogenic bladder diagnosis were not found to be associated with increased high-grade complications on multivariate analysis. Kaplan-Meier survival analysis demonstrated a 1- and 5-year survival of 88.4% and 77.2%, respectively. The long-term survival of patients who experienced higher-grade complications was not statistically different from the survival of the rest of the group. CONCLUSIONS: In this population of patients undergoing urinary diversion, extended case duration and hemodynamic instability during or immediately after surgery are associated with developing a high-grade complication within 90 days of surgery. However, these complications did not impact long-term survival.
e296
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
requiring further intervention, which may help to identify which patients need more aggressive monitoring for potential failures.
Source of Funding: None
PD12-09 CHARACTERIZATION OF INFECTION RISK AFTER RADICAL CYSTECTOMY: RESULTS FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM William Parker*, Matthew Tollefson, Courtney Heins, Kristine Hanson, Elizabeth Habermann, Harras Zaid, Igor Frank, R. Houston Thompson, Stephen Boorjian, Rochester, MN INTRODUCTION AND OBJECTIVES: Radical cystectomy (RC) represents the standard of care for muscle-invasive and high-risk non-muscle invasive bladder cancer. However, RC is associated with a high complication rate, including perioperative infection. In addition to causing patient morbidity, infections have been identified as a quality metric. Herein, we evaluated the incidence, risk factors, and timing of infection following RC. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify patients undergoing RC for bladder cancer from 2005-2013 using CPT procedure and ICD-9 diagnosis codes. Characteristics including age, gender, body-mass index (BMI), diabetes, smoking status, renal function, steroid usage, albumin, perioperative blood transfusion (PBT), and operative time were assessed for their independent association with the risk of infection (inclusive of urinary tract infection (UTI), surgical site infection (SSI), and sepsis) within 30 days of RC using multivariable logistic regression. RESULTS: A total of 3,187 patients were identified, of whom 2,604 (81.8%) were male. Median age was 70 years (IQR 62, 77). Infection within 30 days of RC was diagnosed in 766 (24%) patients, at a median of 13 days (IQR 8, 19) after RC. The most common infections were SSI (404; 12.7%) and sepsis (405; 12.7%), followed by UTI (309; 9.7%). On multivariable analysis (Table), factors significantly associated with an increased risk of postoperative infection were BMI 30 (OR 1.52; p<0.01), receipt of a PBT (OR 1.28; p<0.01), and operative time 480 min (OR 1.69; p<0.01). When the outcomes of UTI, SSI, and sepsis were analyzed separately, operative time 480 min remained independently associated with increased infection risk in each model (OR 2.07 for UTI, OR 1.62 for SSI, and OR 1.74 for sepsis; all p<0.05), while PBT was associated with SSI and sepsis (OR 1.31 and OR 1.35, respectively; both p<0.05). CONCLUSIONS: Approximately 25% of patients undergoing RC experience an infection within 30 days of surgery. Several potentially modifiable risk factors for infection were identified, specifically PBT and prolonged operative time, which represent potential targets for care improvement.
Source of Funding: None
PD12-10 CASE DURATION AND PERIOPERATIVE HYPOTENSION ARE ASSOCIATED WITH GREATER INCIDENCE OF HIGH GRADE COMPLICATIONS IN PATIENTS WHO UNDERGO URINARY DIVERSION FOR BENIGN INDICATIONS Yahir Santiago-Lastra*, Michael R. Mathis, Elizabeth Andraska, Aleda M. L. Thompson, Bahaa S. Malaeb, Anne P. Cameron, J. Quentin Clemens, John T. Stoffel, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: We report the 90-day complications, long-term survival, and perioperative variables associated with greater severity of complications in patients undergoing open urinary diversion (UD) for benign indications. METHODS: We retrospectively reviewed patients who underwent UD for benign indications at a tertiary referral center (2007-2014). Demographic, perioperative, and postoperative variables were extracted. Patients were classified to their most severe complication within 90 days of surgery using the Clavien-Dindo system. Multivariable analysis was performed for variables associated with high-grade complications. Survival data was obtained from the Federal Social Security Death Master File and the State Death Index. RESULTS: 141 patients were included in the analysis. Demographics results are summarized in Table 1. Patients who had a prolonged mean arterial pressure (MAP) below 75% of baseline at any point during the intraoperative period were 10.0 times as likely to have a class III+ complication (95% CI 1.13 to 88.48; p ¼ 0.038) within 90 days. In addition, every 1-minute increase in operative time above the median of 343 minutes increased the odds of a class III+ complication by 1% (95% CI 1.00 to 1.01; p ¼ 0.006). Finally, those who had continuing vasopressor requirement immediately postoperatively (defined as vasopressor infusion occurring in the recovery area) were 5.7 times as likely to have a class III+ complication (95% CI 1.24 to 25.78; p ¼ 0.025). Age, low functional status, increased BMI, history of radiation and high-risk neurogenic bladder diagnosis were not found to be associated with increased high-grade complications on multivariate analysis. Kaplan-Meier survival analysis demonstrated a 1- and 5-year survival of 88.4% and 77.2%, respectively. The long-term survival of patients who experienced higher-grade complications was not statistically different from the survival of the rest of the group. CONCLUSIONS: In this population of patients undergoing urinary diversion, extended case duration and hemodynamic instability during or immediately after surgery are associated with developing a high-grade complication within 90 days of surgery. However, these complications did not impact long-term survival.