Metabolic syndrome, obesity, and radical cystectomy complications: A clavien classification system-based analysis

Radical cystectomy (RC) remains a surgical procedure with significant morbidity. Our retrospective cohort study, based on a standardized complications reporting system, shows that RC is associated with 19.2% of high grade early complications and 1.7% of death rate. Metabolic syndrome (MetS) and, separately, waist circumference represent independent risk factors for high-grade complications (odds ratio [OR], 1.3; P = .010 and OR, 1.9; P = .022, respectively). Introduction/Background: The objective of this study was to evaluate the effect of MetS and its components on the early complications observed in patients treated with RC and urinary diversion. Patients and Methods: We retrospectively analyzed 346 patients with bladder cancer undergoing RC with standard lymphadenectomy, according to the procedure suggested by the International Consultation on Bladder Cancer, and urinary diversion. All early complications within 90 days of surgery were recorded and collected according to the 10 Martin criteria and classified according to the established 5 grades of the modified Clavien classification system (CCS). MetS was defined according to the National Cholesterol Educational Program's Third Adult Treatment Panel. A binary logistic regression analysis was used to analyze MetS and, separately, its single components, as possible independent risk factors for high-grade complications. Results: A total of 323 complications occurred in 231 of 346 patients (66.8%). The rates for low-grade (CCS I-II) and high-grade complications (CCS III-V), and mortality within 90 days (CCS V), were 80.8% (261 of 323), 19.2% (62 of 323), and 1.7% (6 of 346), respectively. At univariate analysis, MetS patients showed a higher rate of high-grade complications compared with patients without MetS (P < .001). At binary logistic regression analysis, MetS (OR, 1.3; P = .010), waist circumference (OR, 1.9; P = .022) and, only in single model, urinary diversion (OR, 1.3; P = .024) were independent risk factors for high-grade complications. Conclusion: RC is a major surgical procedure with a significant early complications rate, nevertheless, most are low-grade complications. MetS and, separately, waist circumference are associated with high-grade complications.