Complications for radical cystectomy - Impact of the American Society of Anesthesiologists score

Objectives: To report the perioperative events after radical cystectomy and urinary diversion in bladder cancer in terms of major and minor complicati ons and to seek statistical relationships with patient's characteristics an d surgical procedures. Methods: One hundred and sixty-one radical cystectomies performed in the mo dern era in two academic hospitals were reviewed. Preoperative patients cha racteristics (age, sex, hemoglobin, total protein, weight and height) and p erioperative data (operative time, type of urinary diversion, associated pr ocedures, blood transfusion, seniority of the surgeon) were recorded. Perio perative morbidity was defined by any adverse event during hospital stay or within 30 days after surgery, those requesting an additional stay of more that 3 days in the intensive care unit or a reoperation being classified as major complications. Significant relationships were sought for classes by Student's t test for comparison of quantitative variables and Yate's correc ted chi (2) test for categorical variables. Spearman's rank correlation tes t was used for comparison of quantitative variables. Results: Major complications were observed in 41 patients (25.5%) and resul ted in 14 reoperations (8.7% reoperation rate). Most of them were diversion -related and were statistically related to the ASA score greater than or eq ual to3 (p<0.01, 5.7 odds ratio). Compared to sophisticated means of divers ion, cutaneous diversion resulted in minimal operative time and hospital st ay. No relationships between age, body mass index, biological parameters, t ype of diversion, associated procedure, surgeon's experience and postoperat ive complications could be evidenced. Uneventful recovery resulted in a 16. 6 days mean hospital stay, minor complications induced a significant 3.8 da ys additional stay and major complications resulted in major lengthening of hospital stay (21.2 days mean additional stay). Conclusion: ASA scores equal to or greater than 3 were associated with majo r complications and most specially those related to the type of urinary div ersion. Therefore, we recommend special care in the selection of the type o f urinary diversion and further preoperative evaluation inclusive of nutrit ional assessment. Copyright (C) 2001 S. Karger AG, Basel.