Patients undergoing cystectomy often have significant baseline cardiac disease. Despite pre-operative medical optimization, post-operative cardiac complications remain a significant source of morbidity. We sought to evaluate risk factors for post-cystectomy cardiac complications (POCC).
A retrospective review of all radical cystectomies for bladder cancer from 1/2004 through 9/2006 was performed. Twelve pre-operative risk factors were evaluated including age, Charleson Co-morbidity index, type of urinary diversion, and prior cardiac history. All complications were recorded for 90 days post-operatively including myocardial infarction (MI) and new onset arrhythmia (NOA). Univariate and multivariate analysis were performed.
283 patients underwent cystectomy for bladder cancer from 1/2004 to 9/2006. The median age of the cohort was 70 (35–90). 64 pts (23%) had a significant pre-operative cardiac history, including 18 (6%) with prior coronary artery bypass and 30 (11%) with a history of MI’s. Thirty-one (11%) patients had either NOA (22, 8%) or MI (10, 4%); one had both. On univariate analysis, cardiac history, age, type of urinary diversion, and the Charleson co-morbidity index demonstrated significance. The risk of POCC was associated with ileal conduit urinary diversion (p=0.026, OR 5.58 [1.23–25.36]) and the Charleson Index score (p=0.030, OR 1.28 [1.024–1.60]) on multivariate analysis.
Multiple, inter-related factors may predict cardiac complications in the early post-operative period. Despite peri-operative optimization, patients with a prior cardiac history should be counseled regarding the increased risk of postoperative cardiac complications. The association between cardiac complications and ileal conduit diversion highlights the selection bias towards patients with pre-existing co-morbid disease.