The Effect of Preoperative Clinical Variables on Morbidity and Mortality after Radical Cystectomy

Abstract

Introduction: Bladder cancer, the 10th most common cancer globally, often requires radical cystectomy (RC) for localized muscle-invasive cases. RC is associated with significant morbidity and mortality, influenced by various preoperative clinical factors. Understanding these factors is crucial to optimizing patient outcomes. This study aimed to determine preoperative clinical variables affecting postoperative outcomes, assess the morbidity and mortality following RC, and categorize postoperative events using the Clavien-Dindo system. Methods: A prospective and retrospective observational study was conducted on 40 patients undergoing open radical cystectomy with ileal conduit at the Department of Urology, Nizams Institute of Medical Sciences, Hyderabad, from July 2023 to July 2024. Data on demographic, clinical, and preoperative factors were analyzed for associations with perioperative outcomes. Statistical analyses included chi-square tests and correlation analyses, with significance set at p < 0.05. Results: The mean age was 62.18 years, with a male predominance (90%). Significant predictors of postoperative morbidity included higher BMI, ASA grade, Charlson Comorbidity Index (CCI), intraoperative time, and blood loss (p < 0.05). Smoking was significantly associated with higher morbidity and severe complications. Postoperative complications occurred in 50% of patients, predominantly mild to moderate (40%), while severe complications were observed in 10%. Early mortality was 5%, with long-term mortality at 16%, associated with advanced age, higher BMI, ASA grade, and CCI. Length of hospital stay correlated positively with age, BMI, ASA grade, and CCI. Conclusion: Preoperative factors, including ASA grade, CCI, BMI, and smoking, are critical predictors of RC outcomes. Optimizing modifiable risk factors and implementing targeted perioperative strategies can improve morbidity, mortality, and recovery outcomes.