Perioperative mortality for radical cystectomy in the modern Era: experience from a tertiary referral center

ABSTRACT Purpose To evaluate the perioperative mortality and contributing variables among patients who underwent radical cystectomy (RC) for bladder cancer in recent decades, with comparison between modern (after 2010) and premodern (before 2010) eras. Materials and Methods Using our institutional review board-approved database, we reviewed the records of patients who underwent RC for primary urothelial bladder carcinoma with curative intent from January 2003 to December 2019. The primary and secondary outcomes were 90- and 30-day mortality. Univariate and multivariable logistic regression models were applied to assess the impact of perioperative variables on 90-day mortality. Results A total of 2047 patients with a mean±SD age of 69.6±10.6 years were included. The 30- and 90-day mortality rates were 1.3% and 4.9%, respectively, and consistent during the past two decades. Among 100 deaths within 90 days, 18 occurred during index hospitalization. Infectious, pulmonary, and cardiac complications were the leading mortality causes. Multivariable analysis showed that age (Odds Ratio: OR 1.05), Charlson comorbidity index ≥ 2 (OR 1.82), blood transfusion (OR 1.95), and pathological node disease (OR 2.85) were independently associated with 90-day mortality. Nevertheless, the surgical approach and enhanced recovery protocols had no significant effect on 90-day mortality. Conclusion The 90-day mortality for RC is approaching five percent, with infectious, pulmonary, and cardiac complications as the leading mortality causes. Older age, higher comorbidity, blood transfusion, and pathological lymph node involvement are independently associated with 90-day mortality.

Perioperative mortality for radical cystectomy in the modern Era: experience from a tertiary referral center.

PURPOSE: To evaluate the perioperative mortality and contributing variables among patients who underwent radical cystectomy (RC) for bladder cancer in recent decades, with comparison between modern (after 2010) and premodern (before 2010) eras. MATERIALS AND METHODS: Using our institutional review board-approved database, we reviewed the records of patients who underwent RC for primary urothelial bladder carcinoma with curative intent from January 2003 to December 2019. The primary and secondary outcomes were 90- and 30-day mortality. Univariate and multivariable logistic regression models were applied to assess the impact of perioperative variables on 90-day mortality. RESULTS: A total of 2047 patients with a mean±SD age of 69.6±10.6 years were included. The 30- and 90-day mortality rates were 1.3% and 4.9%, respectively, and consistent during the past two decades. Among 100 deaths within 90 days, 18 occurred during index hospitalization. Infectious, pulmonary, and cardiac complications were the leading mortality causes. Multivariable analysis showed that age (Odds Ratio: OR 1.05), Charlson comorbidity index ≥ 2 (OR 1.82), blood transfusion (OR 1.95), and pathological node disease (OR 2.85) were independently associated with 90-day mortality. Nevertheless, the surgical approach and enhanced recovery protocols had no significant effect on 90-day mortality. CONCLUSION: The 90-day mortality for RC is approaching five percent, with infectious, pulmonary, and cardiac complications as the leading mortality causes. Older age, higher comorbidity, blood transfusion, and pathological lymph node involvement are independently associated with 90-day mortality.

A Gaussian process regression model to predict energy contents of corn for poultry.

The present study proposes a Gaussian process regression (GPR) approach to develop a model to predict true metabolizable energy corrected for nitrogen (TMEn) content of corn samples (as model output) for poultry given levels of feed chemical compositions of crude protein, ether extract, crude fiber, and ash (as model inputs). A 30 corn samples obtained from 5 origins [Brazil (n = 9), China (n = 5), Iran (n = 7), and Ukraine (n = 9)] were assayed to determine chemical composition and TMEn content using chemical analyses and bioassay technique. In addition to GPR model, data were also analyzed by multiple linear regression (MLR) model. Results revealed that corn samples of different origins differ in their gross energy and chemical composition of crude protein, crude fiber, and ash, but no differences were observed for their ether extract and TMEn contents. Based on model evaluation criteria of R2 and root mean square error (RMSE), the GPR model showed satisfactory performance (R2 = 0.92 and RMSE = 33.68 kcal/kg DM) in predicting TMEn and produced relatively better prediction values than those produce by MLR (R2 = 0.23 and RMSE = 104.85 kcal/kg DM). The GPR model may be capable of improving our aptitude and capacity to precisely predict energy contents of feed ingredients to formulate optimal diets for poultry.