Urologic Oncology: Seminars and Original Investigations
Original articleFemale radical cystectomy patients have a higher risk of surgical site infections
Introduction
Radical cystectomy is associated with frequent and often severe adverse events. As systems for recording patient outcomes have become more sensitive and comprehensive over time, the reported risk of adverse events has increased from 20% to 30% in early 1980s to upward of 80% in recent publications [1], [2], [3], [4], [5], [6], [7], [8]. Higher quality data pertaining to adverse events have allowed for more accurate patient counseling and have identified specific complications that may be targeted for improvement with interventions.
One relatively common complications of radical cystectomy is surgical site infection (SSI). SSI have negative impacts on a patient's quality of life, are expensive to the health care system, and may also delay adjuvant treatments [2], [7], [8], [9], [10], [11], [12]. Hence, several investigators have studied risk factors for SSI after radical cystectomy [13], [14], [15], [16], [17], [18], [19]. Characterizing risk factors for SSI is important as they identify patients at highest risk and may help determine why some of these infections occur.
It is reasonable to suggest that sex may be a risk factor for SSI following radical cystectomy because males and females have different pelvic anatomy. Furthermore, even in anatomical regions where anatomy does not differ, such as orthopedic surgery [20], [21], neurosurgery [22], and cardiac surgery [23], [24], female sex has been associated with a higher infection rate. Previous studies of SSI in cystectomy have not included sex in multivariable analysis [16], [17], [18], [19] or were underpowered [13], [14] to detect clinically meaningful differences. The purpose of this study was to evaluate the association between sex and SSI after cystectomy in a large prospective cohort.
Section snippets
Methods
The Ottawa Health Science Network Research Ethics Board approved this study. De-identified and anonymized patient data from the American College of Surgeons’ National Surgical Quality Improvement Program was reviewed from 2006 to 2016. NSQIP data is prospectively derived from over 500 hospitals, mostly in North America. The database is populated through a combination of automated collection and input from trained surgical clinical reviewers. All participating centers capture data for eligible
Results
Between 2006 and 2016, a total of 9,275 radical cystectomy patients (1,877 female and 7,398 male) met inclusion criteria. Baseline characteristics are presented in Table 1. Postoperative SSI occurred in 1,277(13.8%) patients; 308 (16.4%) females and 969 (13.1%) males (odds ratio [OR] = 1.27; 95% confidence interval [CI] 1.10–1.47; P = 0.009). Infections were superficial in 150 (8.0%) females versus 410 (5.5%) males; P < 0.0001), deep in 40 (2.1%) females versus 114 (1.5%) males; P = 0.07), and
Discussion
In this study, we reviewed the incidence of SSI following radical cystectomy. We found that female sex independently increased the odds of SSI by 21%. Furthermore, females that suffered an SSI had a longer length of hospital stay and other complications compared to those who did not.
The incidence of SSI in this cohort is similar to previous studies where the infection risk has been reported between 9% and 32% [2], [14], [16], [17], [18], [19]. It is likely that the range of reported risks
Conclusions
Using a large and contemporary cohort of patients, we found that female sex is an independent risk factor for SSI after cystectomy. Females who experience SSI have higher probability of developing other complications including wound dehiscence, septic shock, and return to the operating room. More detailed information about the incident infections may help determine the reason why females have a higher risk of SSI. Until more information is available, careful vaginal preparation and prophylactic
References (37)
- et al.
Complications of radical cystectomy for carcinoma of bladder
J Urol
(1980) - et al.
Contemporary open radical cystectomy: analysis of perioperative outcomes
J Urol
(2008) - et al.
Early and late complications of robot-assisted radical cystectomy: a standardized analysis by urinary diversion type
J Urol
(2014) - et al.
Perioperative complications of radical cystectomy in a contemporary series
Eur Urol
(2007) - et al.
Long-term outcome study in patients with abdominal wound dehiscence: a comparative study on quality of life, body image, and incisional hernia
J Gastrointest Surg
(2013) - et al.
Characterization of perioperative infection risk among patients undergoing radical cystectomy: results from the national surgical quality improvement program
Urol Oncol
(2016) - et al.
Significance of anaerobic bacteria in postoperative infection after radical cystectomy and urinary diversion or reconstruction
J Infect Chemother
(2013) Surgical site infection after radical cystectomy—incidence and risk factors
J Urol
(2017)- et al.
Surgical site infections in patients who undergo radical cystectomy: excess mortality, stay prolongation and hospital cost overruns
Actas Urol Esp
(2015) - et al.
Decrease in incidence of surgical site infections in contemporary series of patients with radical cystectomy
J Infect Chemother
(2010)
Multivariate analysis of risk factors for deep and superficial sternal infection after coronary artery bypass grafting at a tertiary care medical center
Semin Thorac Cardiovasc Surg
Preoperative hair removal and surgical site infections: network meta-analysis of randomized controlled trials
J Hosp Infect
Pubic hair removal among women in the United States: prevalence, methods, and characteristics
J Sex Med
Predictors of surgical site infection following craniotomy for intracranial neoplasms: an analysis of prospectively collected data in the ACS-NSQIP database
World Neurosurg
Peri-operative morbidity associated with radical cystectomy in a multicenter database of community and academic hospitals
PLoS ONE
Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology
Eur Urol
Post-operative infection and prophylactic antibiotic administration after radical cystectomy with orthotopic neobladder urinary diversion
J Infect Chemother
Radical cystectomy early postoperative complications and mortality rate
Med Arh
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