What question did this study set out to answer?

This study aims to identify the most common early complications after radical cystectomy and their predictors to enhance postoperative care.

May 3, 2026Open Access

Early complications within 30 days after radical cystectomy: The top seven complications and their predictors

SDS. DuarteHospital Prof. Dr. Fernando Fonseca EFEduardo FelícioHospital Prof. Dr. Fernando Fonseca GBGuilherme BernardoHospital Prof. Dr. Fernando Fonseca

Puntos clave

This study aims to identify the most common early complications after radical cystectomy and their predictors to enhance postoperative care.
Retrospective observational study of 202 adult patients undergoing radical cystectomy with urinary diversion at a single institution.
Identified the seven most frequent complications and used univariable and multivariable logistic regression analyses for predictors.
Adjusted odds ratios with 95% confidence intervals were calculated for predictors of each complication.
53.0% of patients experienced at least one complication within 30 days after surgery.
Ileus (25.7%) and wound complications (18.8%) were the most frequent complications identified.
Predictors for complications varied, with certain comorbidities and specifics of surgery influencing outcomes.

Resumen

PURPOSE: Radical cystectomy (RC) is among the most complex procedures in urology, with early morbidity rates exceeding 50%. Understanding which complications occur most often and identifying their predictors may improve perioperative optimization and postoperative surveillance. This study aimed to determine the most common complications occurring within 30 days after RC and to identify their predictors. MATERIALS AND METHODS: We conducted a retrospective observational study of all adult patients undergoing RC with urinary diversion at a single institution between January 2014 and December 2024. A total of 202 patients met inclusion criteria. The seven most frequent complications were identified. Univariable logistic regressions and three separate multivariable models were generated for each complication. Adjusted odds ratios with 95% confidence intervals were reported. RESULTS: Overall, 53.0% of patients experienced at least one complication within 30 days. The seven most frequent complications were ileus (25.7%), wound complications (18.8%), urinary tract infection (UTI) (18.3%), sepsis (13.4%), evisceration (11.9%), respiratory infection (5.9%), and bowel anastomotic leak (4.5%). Ileus was predicted by intraoperative complications and urinary diversion type. Wound complications were associated with higher Charlson comorbidity index (CCI), sepsis, ileus, and open surgery. Sepsis was predicted by hypertension, advanced-stage disease, ileus, wound complications, and bowel anastomotic leak. No independent predictors were identified for early UTI. Respiratory infection was associated with postoperative ileus. Evisceration was strongly associated with CCI, intraoperative complications, ileus, and bowel anastomotic leak. CONCLUSIONS: Early morbidity after RC remains high. Predictor profiles differed across complications, supporting the need for complication-specific perioperative strategies.

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