Preoperative Nutritional Status and The Impact on Radical Cystectomy Recovery: An International Comparative Study

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Abstract

Introduction

Early complication rates after radical cystectomy remain relatively high. Increased awareness of poor nutrition as a comorbidity and attention to nutritional status in the early preoperative period may enhance and facilitate postoperative recovery and decrease length of stay.

Purpose

To investigate and compare the prevalence of patients at nutritional risk and their level of comorbidity by a retrospective chart review. A second goal was to identify similarities in two independent cohorts and identify potential factors associated with length of stay.

Methods

Patients were identified from two high-volume urologic departments via retrospective chart review. initial analysis was completed with descriptive statistics; regression analysis was completed to investigate possible associations between length of stay and covariates.

Primary Outcome Measures

Length of stay, nutritional status, age, sex, and comorbidities were the primary measures of interest for comparison between sites.

Results

There was no statistical significant association between nutritional status, comorbidity, and length of stay, although both centers documented that high nutritional risk prolonged length of stay. comparing sites, both being a woman and age were found as a significant independent predictors of length of stay at Aarhus University Hospital but not at Memorial sloan Kettering cancer center. in both centers, the magnitude of the numbers of patients already at a high nutritional risk preoperatively indicates the severity of the problem and eradicates any doubts concerning the necessity of early screening and adequate timely interventions.

Conclusion

Preoperative nutritional status is an important measurement in any radical cystectomy pathway and should be included in all standard care pathways. This study further highlights the need for global consensus of definition of nutritional risk and status.

Level of Evidence - VI

(Polit & Beck, 2012)

Level of Evidence - VI

In radical cystectomy, under-nutrition is common and has detrimental physiological and clinical effects, which can lead to increased complications and prolonged recovery. This article compares measurements and outcomes across continents in this patient population with advanced bladder cancer. The association of preoperative nutritional risk, nutritional status, and length of stay is equal across continents, and the results promote increased clinical awareness that women at severe risk should be identified preoperatively.

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