Gender Disparity in Cystectomy Postoperative Outcomes: Propensity Score Analysis of the National Surgical Quality Improvement Program Database
| Autor: | David Sheyn, Kirtishri Mishra, Jason T. Jankowski, Amr Mahran, Anjali Shekar, Carvell T Nguyen, Emily A. Slopnick, Laura Bukavina, Lee Ponsky, Adoniz Hijaz |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Urology medicine.medical_treatment 030232 urology & nephrology Cystectomy computer.software_genre Logistic regression 03 medical and health sciences Postoperative Complications 0302 clinical medicine Humans Medicine Radiology Nuclear Medicine and imaging Statistical analysis Postoperative Period Propensity Score Gender disparity Retrospective Studies Bladder cancer Database business.industry Odds ratio medicine.disease Quality Improvement Acs nsqip Oncology 030220 oncology & carcinogenesis Propensity score matching Female Surgery business computer |
| Zdroj: | European Urology Oncology. 4:84-92 |
| ISSN: | 2588-9311 |
| DOI: | 10.1016/j.euo.2019.04.004 |
| Popis: | Background While female gender is considered a protective determinant in the majority of cancers, outcomes in women diagnosed with bladder cancer have continued to show disproportional mortality when compared with men. Objective The aim of this retrospective propensity score-matched analysis was to evaluate the intra- and postoperative differences among genders, as well as to evaluate reproductive organ-preserving radical cystectomy (ROPRC) as compared with radical cystectomy (RC) as a potential confounder in female cystectomy patients. Design, setting, and participants Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), men and women undergoing a cystectomy between 2011 and 2017 were analyzed. In addition, females undergoing ROPRC and RC were analyzed for immediate postoperative outcomes. Outcome measurements and statistical analysis Men and women undergoing a cystectomy were evaluated through propensity score matching (PSM) for baseline differences using a 1:1 caliper width of 0.2 to the nearest neighbor. Using multivariable logistic regression analysis, we evaluated differences in the risk of readmission, complications, and reoperation in the immediate postsurgical period in males and females. Similarly, differences were assessed in ROPRC and RC groups. Results and limitations We achieved a balance between males and females after PSM: 1263 males and 1263 females treated with cystectomy. 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 (aOR 2.031 [1.713–2.411], p Conclusions Using the 2011–2017 NSQIP database, we were able to demonstrate an increased rate of postoperative transfusion, readmission rate, and surgical site infection in females who underwent cystectomy. Our findings suggest that females experience an increased rate of complications in the immediate postoperative period. This may ultimately lead to worse oncologic outcomes in females after an RC. Lastly, we did not find any increased rate of complications in ROPRC as compared with RC. Patient summary This study highlights differences in immediate postoperative outcomes between males and females undergoing cystectomy for bladder cancer. Some of these potential differences include higher risk of infection, transfusion, and readmission. These differences may predispose females to worse long-term outcomes. In addition, due to potential benefits of ovarian preservation in the recent literature, we also evaluated the risks and complications of ovarian sparing cystectomy. We found ovarian preservation to be a safe and feasible procedure in a highly selected group of patients. |
| Databáze: | OpenAIRE |
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