Perioperative Complications and In-Hospital Mortality in Paraplegic Radical Cystectomy Patients

Paraplegic patients represent a challenging-to-treat population. Specifically, due to the bladder function deficiency, they are life-long catheterized. This condition increases the incidence of squamous cell carcinoma of the bladder. While for non-paraplegic patients with a diagnosis of squamous bladder cancer (BCA), radical cystectomy (RC) is highly recommended, guidelines do not address paraplegic BCA patients.

According to previous reports relying on a very small sample size, paraplegic BCA patients may have worse in-hospital outcomes at RC. Recently, a novel population-based study, relying on National Inpatient Sample (2000-2019), quantified the contemporary in-hospital outcomes rates, addressing an important clinical unmet need.¹

The study included 25,527 non-metastatic BCA patients. Of those, 185 (0.7%) were paraplegic. This rate suggests the rarity of this condition for which the number are narrowed even in a large-scale population-based dataset over a period of 20 years.

Unfortunately, the NIS database does not account for cancer characteristics and surgery expertise, allowing only a snapshot of inpatient paraplegic patients underwent RC. However, the in-hospital outcomes at RC were untoward and worthy of proper preoperative counseling.

Key Findings

Paraplegic BCA patients had a four-fold higher risk of in-hospital mortality and two-fold higher risk of critical care therapy (CCT) use.
Among adverse in-hospital outcomes, paraplegic BCA patients were more likely to exhibit infections, intraoperative complications, wound, and pulmonary complications as well as to receive blood transfusions.

Clinical Implications and Conclusions

Paraplegic BCA patients had a higher risk of in-hospital mortality, CCT use as well as specific complications at RC. The highest risk for paraplegic BCA patients is represented by the infection rates. In order to reduce in-hospital mortality as well as untoward events at RC, paraplegic BCA patients should be carefully selected for RC and preoperatively optimized. For instance, further studies might validate the presence of an advantage in younger paraplegic BCA patients compared to their older counterparts.

Written by: Francesco Di Bello, Resident in Urology, University of Naples Federico IIVia Pansini, Naples, Italy; Research fellow, University of Montréal Hospital Center (CHUM), Montréal, Canada

Reference:

Di Bello F, Siech C, de Angelis M, Rodriguez Peñaranda N, Tian Z, Goyal JA, et al. Perioperative Complications and In-Hospital Mortality in Paraplegic Radical Cystectomy Patients. Ann Surg Oncol. 8 ottobre 2024

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