Complicaciones posquirúrgicas en cistectomías radicales a 30 días: factores relacionados y uso de la escala de APGAR quirúrgico para su predicción
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v82i4.865Palabras clave:
Cáncer de vejiga, cistectomía radical, escala APGARResumen
Objective: Bladder cancer represents the seventh most common cancer with highly variable morbidity and mortality due to detection, treatment and follow-up strategies, with radical cystectomy (RC) being the treatment that offers the best oncological control. A morbidity rate between 30-93% has been reported at 30 days, and mortality greater than 8%. This variability is due to the scarcity of standardized reports using scales such as Clavien-Dindo (CD). Due to the little evidence of publications on complications associated with RC, we decided to make a standardized report of these, using the CD scale of the RCs performed in our hospital, with the goal of finding out the incidence and real severity of these.
Materials and methods: A retrospective analysis was made of a prospectively maintained database of RCs performed in our center between 1994 and 2019. All patients over 18 years of age who underwent RC during the study period were included, and all patients with incomplete documentation of the immediate 30 day-postoperative were excluded. Descriptive statistics were used for data presentation. The Kolmogorov-Smirnov test was used to determine the data distribution. An inferential mean comparison analysis was performed using the Student's t-test for variables with normal distribution, and non-parametric tests (Mann–Whitney U-test) for those with non-normal distribution.
Results: The mean age of the study population was 61.16 years (SD 10.1). Patients without major complications had a BMI 2.45 kg/m2 lower compared to patients with major complications (95% CI -4.7 to -0.18). Bleeding and surgical time, as well as type of derivation, were not significantly associated with major complications.
Study limitations: It was a retrospective study, so the SAS could not be calculated for the entire population. Also, it was a small cohort of patients in a tertiary care center with a restricted number of hospital beds, which considerably reduces the statistical power of the study to find low-frequency events (mortality). Extending the follow-up to more than 30 days could modify the incidence of complications.
Originality: Our series is the first to use a standardized system (Clavien-Dindo scale) to report postoperative complications in patients undergoing RC in Mexico.
Conclusions: RC continues to be one of the surgeries with the highest morbidity. The use of standardized scales for reporting complications associated with RC would allow us to establish prevention strategies and establish homogeneous surveillance criteria with other specialties.
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