Real-World Study of Short-Term and Long-Term Clinical Outcomes With Radical Cystectomy for Bladder Cancer in the United States

Purpose: Using real-world data, this study aimed to provide a descriptive assessment of the longitudinal occurrence and severity of complications and relevant comorbidities that arise in bladder cancer patients who received radical cystectomy (RC). Materials and Methods: Claims data between October 01, 2015, and April 24, 2023, were assessed to determine relevant complications or comorbidities occurring within 90 days and up to 5 years of follow-up for RC; an exploratory assessment of trimodal therapy (transurethral resection of bladder tumor, chemotherapy, and radiotherapy) was performed and results provided as Supplemental Material (http://links.lww.com/JU9/A123). Clinical outcomes were stratified into categories, and the severity of complications was graded according to Clavien-Dindo classifications. Aspects of treatment recommended guidelines (ie, neoadjuvant chemotherapy and radiotherapy fractions received) were explored through subgroup analyses. Results: Of the 839 patients who underwent RC (median age 71 years; 26.2% female), 25.1% (n = 211) of patients received neoadjuvant chemotherapy. A large proportion of patients experienced infection and sepsis (36.5%), gastrointestinal (40.9%), and genitourinary-related complications/comorbidities (37.8%) during the first 90 days. Psychiatric conditions were also notable, occurring in 29.2% of patients by 90 days and increasing to 56.3% by 5 years. Grade IV complications were experienced by 25.1% of patients, rising to 46.6% by 5 years. Conclusions: The findings reveal the substantial burden of complications/comorbidities experienced by patients who undergo RC for bladder cancer. Through comprehensive reporting on the type and severity of complications or comorbidities, this study offers a longitudinal perspective into the clinical outcomes that occur in diverse patient populations in real-world settings across the United States.