The Effect of Chronic Liver Disease on Adverse In-Hospital Outcomes After Radical Cystectomy and Ileal Conduit Urinary Diversion.

BACKGROUND

Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder cancer (BCa). Chronic liver disease (CLD) may predispose to worse in-hospital outcomes after RC and ileal conduit, but this association has not been investigated. The current study addressed this knowledge gap.

METHODS

Descriptive analyses, propensity score-matching (PSM), and multivariable logistic and Poisson regression models were used to address BCa patients in the National Inpatient Sample treated with RC and ileal conduit (2006-2019).

RESULTS

Of 15,104 RC and ileal conduit patients, 241 (1.6 %) had CLD at baseline. Compared with their non-CLD counterparts, the CLD patients exhibited significantly higher rates of adverse in-hospital outcomes in 9 of 13 categories, namely, acute kidney injury (AKI, Δ+12.0 %), overall complications (Δ+11.0 %), pulmonary complications (Δ+9.0 %), blood transfusions (Δ+8.0 %), prolonged hospital stay (Δ+7.0 %), infectious complications (Δ+7.0 %), critical care therapies (Δ+4.0 %), in-hospital mortality (Δ+3.6 %), and total hospital charges (THC, Δ+18, 042 US$) (all p < 0.05). After multivariable adjustment, CLD independently predicted higher rates of adverse in-hospital outcomes in the same categories, namely, in-hospital mortality (odds ratio [OR], 2.7; 95 % confidence interval [CI], 1.3-4.9), infectious complications (OR, 2.5; 95 % CI 1.6-3.8), AKI (OR, 2.1; 95 % CI 1.6-2.9), pulmonary complications (OR, 2.0; 95 % CI 1.4-2.8), overall complications (OR, 1.9; 95 % CI 1.7-2.9), critical care therapies (OR, 1.6; 95 % CI 1.2-1.9), blood transfusions (OR, 1.4; 95 % CI 1.1-1.9), prolonged hospital stay (OR, 1.4; 95 % CI 1.1-1.8), and THC (OR, 1.2; 95 % CI 1.1-1.4) (all p < 0.05).

CONCLUSIONS

Although CLD appears to predispose to higher rates of adverse in-hospital outcomes after RC and ileal conduit, it does not increase the rates of these outcomes in a prohibitive fashion.