The impact of high-grade complications on quality of life and psychosocial distress in the early period after radical cystectomy.

OBJECTIVES

This study aims to investigate the impact of high-grade complications (i.e., Clavien-Dindo Classification [CDC] Grade ≥III) on quality of life (QoL) and psychosocial distress (PD) in the early period after radical cystectomy (RC) and urinary diversion.

PATIENTS AND

METHODS

The study relied on prospectively collected data of patients undergoing 3 weeks of inpatient rehabilitation (IR) after RC and urinary diversion (ileal conduit [IC] or ileal neobladder [INB]) between 04/2018 and 12/2019. Patients were surveyed on QoL (EORTC QLQ-C30) and PD (QSC-R10) by validated questionnaires at the beginning and the end of IR. Information about complications before the start of IR was taken from the hospital discharge letters and patient interview.

RESULTS

Overall, 842 patients were enrolled. High-grade complications occurred in 25.5% of patients. Men (27.4% vs. 17.6%, p = 0.011) and patients with an INB (28.9% vs. 22.6%, p = 0.037) were significantly more susceptible to high-grade complications. At the beginning of IR, health-related QoL (HRQoL), role and social functioning were significantly lower in patients with a high-grade complication. Both HRQoL and the proportion of patients with high PD improved significantly during IR (p < 0.001, respectively). A multivariable linear regression analysis identified high-grade complications to significantly impact HRQoL (p = 0.013). Meanwhile, age (p = 0.001), INB (p = 0.019) and high-grade complications (p = 0.01) significantly contributed to PD.

CONCLUSION

High-grade complications after RC and urinary diversion significantly impair short-term QoL and PD, warranting constant physical and psychosocial monitoring.