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Impact of complications and hospital-free days on health related quality of life 1 year after radical cystectomy.

Ritch CR, Cookson MS, Chang SS, Clark PE, Resnick MJ, Penson DF, Smith JA, May AT, Anderson CB, You C, Lee H, Barocas DA
J Urol. 2014 192 (5): 1360-4

PMID: 24928268 · DOI:10.1016/j.juro.2014.06.004

PURPOSE - We determined the extent to which complications as well as number of hospital-free days within 30 and 90 days of surgery predicted health related quality of life 1 year after radical cystectomy.

MATERIALS AND METHODS - We used data from a prospective health related quality of life study using a validated instrument, the Vanderbilt Cystectomy Index-15. Complications were graded by the Clavien system, and hospital length of stay and length of stay during readmissions were used to calculate 30 and 90-day hospital-free days, respectively. We compared the number of hospital-free days among patients with varying levels of complications. Multivariate analysis was performed to determine predictors of Vanderbilt Cystectomy Index-15 score 1 year after surgery adjusting for demographic (age, gender, comorbidities) and clinical variables (stage and diversion type).

RESULTS - A total of 100 patients with complete baseline and 1-year followup health related quality of life data were included in the analysis. Median (IQR) 30 and 90-day hospital-free days were 24 (22-25) and 84 (82-85), respectively. Patients who experienced any complications had significantly fewer 30-day hospital-free days (22 vs 24 days, p <0.01) and 90-day hospital-free days (81 vs 84 days, p <0.01), and patients with higher grade complications had fewer hospital-free days than those with lower grade or no complications (p <0.01). On multivariate analysis female gender and baseline Vanderbilt Cystectomy Index-15 score independently predicted higher 1-year health related quality of life scores.

CONCLUSIONS - Patients who experience complications after radical cystectomy have fewer 30 and 90-day hospital-free days. However, neither predicts health related quality of life at 1 year. Instead, long-term health related quality of life appears to be driven largely by baseline health related quality of life and gender.

Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

MeSH Terms (16)

Aged Cystectomy Female Follow-Up Studies Humans Length of Stay Male Patient Discharge Patient Readmission Postoperative Complications Prospective Studies Quality of Life Time Factors Treatment Outcome United States Urinary Bladder Neoplasms

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