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Gender Disparities in Clinical Outcomes after Cystectomy - Expert Commentary

Understanding the demographic factors which affect clinical outcomes following radical cystectomy (RC) is critical for improving oncologic outcomes for all patients. A recent study published in European Urology Oncology examined intraoperative and postoperative differences in outcomes between male and female patients who underwent radical cystectomy.
The investigators examined the American Cancer Society National Surgical Quality Improvement Program (ACS-NSQIP) database for patients who had a cystectomy between 2011 and 2017. They used propensity score matching (PSM) and multivariable logistic regression analysis to evaluate the role of sex as a clinical variable that affects outcomes. The study assessed complications, and reoperation in the immediate postsurgical and differences in reproductive organ-preserving radical cystectomy (ROPRC) and RC groups.

After propensity score matching, the investigators found that the the risks of readmission (adjusted odds ratio [aOR] 1.228 [1.005–1.510], p = 0.045), superficial surgical site infection (aOR 1.507 [1.095–2.086], p = 0.012), and transfusion rates (aOR 2.031 [1.713–2.411], p < 0.001) were higher in women undergoing cystectomy compared to men. They found no significant differences in surgical outcomes between women undergoing ROPRC and those undergoing RC.

Additional research is needed to understand the reasons behind disparities in clinical outcomes between men and women. Addressing these disparities will lead to improved clinical outcomes.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York

Reference:

1. Bukavina, Laura, Kirtishri Mishra, Amr Mahran, Anjali Shekar, David Sheyn, Emily Slopnick, Adoniz Hijaz, Jason Jankowski, Lee Ponsky, and Carvell Nguyen. "Gender Disparity in Cystectomy Postoperative Outcomes: Propensity Score Analysis of the National Surgical Quality Improvement Program Database." European Urology Oncology (2019).

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