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World Journal of Urology
Published in: World Journal of Urology 7/2017

01-07-2017 | Original Article

The impact of socioeconomic status on perioperative complications and oncologic outcomes in patients undergoing radical cystectomy

Authors: David M. Golombos, Padraic O’Malley, Patrick Lewicki, Daniel P. Nguyen, Benjamin V. Stone, Bashir Al Hussein Al Awamlh, Douglas S. Scherr

Published in: World Journal of Urology | Issue 7/2017

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Abstract

Purpose

To examine if patients of lower socioeconomic status (SES) are at higher risk of perioperative complications and experience different oncologic outcomes after radical cystectomy (RC).

Methods

Retrospective review was performed on 383 consecutive non-metastatic patients who underwent definitive RC at a tertiary referral center. Along with clinical and pathologic parameters traditionally utilized for risk stratification, potential social determinants of health were estimated using US Census data. Zip code-derived proxies of SES included median annual household income and percentage of residents completing high school education. Patients were grouped based on SES parameters, and potential differences were assessed. Multivariable logistic regression was then performed to identify predictors of complication within 90 days of RC. Survival outcomes were plotted using Kaplan–Meier survival curves.

Results

Overall, 167 (46.2%) patients suffered any complication within 90 days of RC. On multivariable analysis, length of stay (p ≤ 0.001), lower income grouping (p = 0.03), and lowest education tertile (p = 0.007) were significant predictors of any complication. Income (p = 0.04) and education (p = 0.008) groupings remained significant predictors in a subset analysis looking specifically at post-discharge complications. No significant differences in recurrence-free or overall survival estimates were observed among education (log-rank test: p > 0.9 and p = 0.6, respectively) or income (log-rank test: p = 0.2 and p = 0.09, respectively) groupings.

Conclusion

Patients of lower socioeconomic status who undergo RC for bladder cancer are at increased risk of perioperative complications. Further studies are needed to clarify this relationship, and to explore interventions aimed to improve outcomes.
Appendix
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Metadata
Title
The impact of socioeconomic status on perioperative complications and oncologic outcomes in patients undergoing radical cystectomy
Authors
David M. Golombos
Padraic O’Malley
Patrick Lewicki
Daniel P. Nguyen
Benjamin V. Stone
Bashir Al Hussein Al Awamlh
Douglas S. Scherr
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 7/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-016-1972-6

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