Effect of Neoadjuvant Chemotherapy on Complications, in-Hospital Mortality, Length of Stay and Total Hospital Costs in Bladder Cancer Patients Undergoing Radical Cystectomy

Background: To test for differences in complication rates, in-hospital mortality, length of stay (LOS) and total hospital costs (THCs) in patients treated with neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC). Methods: Within the National (Nationwide) Inpatient Sample (NIS) database (...

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Published in:Cancers 2022-02, Vol.14 (5), p.1222
Main Authors: Hoeh, Benedikt, Flammia, Rocco Simone, Hohenhorst, Lukas, Sorce, Gabriele, Chierigo, Francesco, Panunzio, Andrea, Tian, Zhe, Saad, Fred, Gallucci, Michele, Briganti, Alberto, Terrone, Carlo, Shariat, Shahrokh F, Graefen, Markus, Tilki, Derya, Antonelli, Alessandro, Kluth, Luis A, Mandel, Philipp, Chun, Felix K H, Karakiewicz, Pierre I
Format: Article
Language:English
Subjects:
Bladder cancer
Chemotherapy
Codes
Heart
Hospital costs
Invasiveness
Length of stay
Medicaid
Medicare
Metastases
Mortality
Patients
Regression analysis
Urinary bladder
Urothelial carcinoma
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creator Hoeh, Benedikt
Flammia, Rocco Simone
Hohenhorst, Lukas
Sorce, Gabriele
Chierigo, Francesco
Panunzio, Andrea
Tian, Zhe
Saad, Fred
Gallucci, Michele
Briganti, Alberto
Terrone, Carlo
Shariat, Shahrokh F
Graefen, Markus
Tilki, Derya
Antonelli, Alessandro
Kluth, Luis A
Mandel, Philipp
Chun, Felix K H
Karakiewicz, Pierre I
description Background: To test for differences in complication rates, in-hospital mortality, length of stay (LOS) and total hospital costs (THCs) in patients treated with neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC). Methods: Within the National (Nationwide) Inpatient Sample (NIS) database (2016−2019), we identified RC-treated, non-metastatic, lymph-node negative bladder cancer patients, stratified by NAC status. Trend analyses, multivariable logistic, multivariable Poisson and multivariable linear regression models were used. Results: We identified 4347 RC-treated bladder cancer patients. Of those, 805 (19%) received NAC prior to RC. Overall, complications rates did not differ (65 vs. 66%; p = 0.7). However, NAC patients harbored lower rates of surgical site (6 vs. 9%), cardiac (13 vs. 19%) and genitourinary (5.5 vs. 9.7%) complications. In-hospital mortality (
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Methods: Within the National (Nationwide) Inpatient Sample (NIS) database (2016−2019), we identified RC-treated, non-metastatic, lymph-node negative bladder cancer patients, stratified by NAC status. Trend analyses, multivariable logistic, multivariable Poisson and multivariable linear regression models were used. Results: We identified 4347 RC-treated bladder cancer patients. Of those, 805 (19%) received NAC prior to RC. Overall, complications rates did not differ (65 vs. 66%; p = 0.7). However, NAC patients harbored lower rates of surgical site (6 vs. 9%), cardiac (13 vs. 19%) and genitourinary (5.5 vs. 9.7%) complications. In-hospital mortality (&lt;1.7 vs. 1.8%) and LOS (6 vs. 7 days) was lower in NAC patients (all p &lt; 0.05). Moreover, NAC was an independent predictor of shorter LOS in multivariable Poisson regression models (Risk ratio: 0.86; p &lt; 0.001) and an independent predictor for higher THCs in multivariable linear regression models (Odds ratio: 1474$; p = 0.02). Conclusion: NAC was not associated with higher complication rates and in-hospital mortality. Contrary, NAC was associated with shorter LOS, yet moderately higher THCs. The current analysis suggests no detriment from NAC in the context of RC.</description><identifier>ISSN: 2072-6694</identifier><identifier>EISSN: 2072-6694</identifier><identifier>DOI: 10.3390/cancers14051222</identifier><identifier>PMID: 35267529</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Bladder cancer ; Chemotherapy ; Codes ; Heart ; Hospital costs ; Invasiveness ; Length of stay ; Medicaid ; Medicare ; Metastases ; Mortality ; Patients ; Regression analysis ; Urinary bladder ; Urothelial carcinoma</subject><ispartof>Cancers, 2022-02, Vol.14 (5), p.1222</ispartof><rights>2022 by the authors. Licensee MDPI, Basel, Switzerland. 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Methods: Within the National (Nationwide) Inpatient Sample (NIS) database (2016−2019), we identified RC-treated, non-metastatic, lymph-node negative bladder cancer patients, stratified by NAC status. Trend analyses, multivariable logistic, multivariable Poisson and multivariable linear regression models were used. Results: We identified 4347 RC-treated bladder cancer patients. Of those, 805 (19%) received NAC prior to RC. Overall, complications rates did not differ (65 vs. 66%; p = 0.7). However, NAC patients harbored lower rates of surgical site (6 vs. 9%), cardiac (13 vs. 19%) and genitourinary (5.5 vs. 9.7%) complications. In-hospital mortality (&lt;1.7 vs. 1.8%) and LOS (6 vs. 7 days) was lower in NAC patients (all p &lt; 0.05). Moreover, NAC was an independent predictor of shorter LOS in multivariable Poisson regression models (Risk ratio: 0.86; p &lt; 0.001) and an independent predictor for higher THCs in multivariable linear regression models (Odds ratio: 1474$; p = 0.02). 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subjects Bladder cancer
Chemotherapy
Codes
Heart
Hospital costs
Invasiveness
Length of stay
Medicaid
Medicare
Metastases
Mortality
Patients
Regression analysis
Urinary bladder
Urothelial carcinoma
title Effect of Neoadjuvant Chemotherapy on Complications, in-Hospital Mortality, Length of Stay and Total Hospital Costs in Bladder Cancer Patients Undergoing Radical Cystectomy
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