Perioperative Complications and In-hospital Mortality After Cystectomy for Nonbladder Cancer Conditions Versus Radical Cystectomy for Bladder Cancer

Objective: This study was designed to test for perioperative complications, mortality, and length of stay after cystectomy for nonbladder cancer (non-BCa) v radical cystectomy (RC) for bladder cancer (BCa). Methods: Patients were identified within the National Inpatient Sample (2000-2019). Multivariable logistic and Poisson regression models were fitted. Results: Of 26,721 cystectomy patients, 1314 (5%) harbored non-BCa diagnosis: 515 (39%) neurogenic bladder; 379 (29%) radiation cystitis; 238 (18%) interstitial cystitis; 181 (14%) bladder fistula. Relative to RC for BCa, cystectomy for neurogenic bladder, radiation cystitis and bladder fistula resulted in higher genitourinary (22-39 vs. 14%; multivariable odds ratios [MOR] 1.7-3.8), infectious (7-8 vs. 4%; MOR 1.5-2.3), and wound (9 vs. 5%; MOR 1.5-2.0) complications rates. Only cystectomy for neurogenic bladder resulted in higher pulmonary complications (15 vs. 11%; MOR 1.8). Additionally, cystectomy for neurogenic bladder and bladder fistula independently predicted 1.5-fold higher rate of critical care therapy (CCT) use, but only cystectomy for neurogenic bladder exhibited 2.4-fold higher in-hospital mortality rate. Finally, cystectomy for neurogenic bladder, radiation cystitis, and bladder fistula resulted in higher rates of hospital stay ≥ 75th percentile (33-47 vs. 27%; MOR 1.7-2.8). Conclusions: Relative to RC for BCa, cystectomy for three of four non-BCa conditions resulted in higher rates of four of 12 in-hospital adverse outcomes. Additionally, cystectomy for two of four non-BCa conditions resulted in higher CCT use, but only cystectomy for neurogenic bladder predicted higher rate of in-hospital mortality.