Effect of Postcystectomy Infectious Complications on Cost, Length of Stay, and Mortality

OBJECTIVES To analyze the effect of infectious complications after cystectomy using the Nationwide Inpatient Samples of the Healthcare Cost and Utilization Project. The economic and clinical effects of infectious complications after radical cystectomy have not been analyzed. METHODS All 6686 patients undergoing radical cystectomy for bladder cancer were identified from the nationwide inpatient samples from 2000 to 2004. Septicemia, bacterial infections, and mycosis were categorized using the Clinical Classification Software. We then analyzed the effect of septicemia on in-hospital mortality, length of stay, and total hospital charges. RESULTS Of the 6686 patients, 241 (3.6%) were diagnosed with septicemia after cystectomy. The overall, in-hospital mortality rate was 16.67% (n = 33). Septicemia was a significant predictor of in-hospital mortality (P < .001). The mean hospital charge for patients with septicemia was nearly 3 times the amount for the control patients ($161 277 vs $58 560, P < .001). The length of stay was 3 times longer for patients with septicemia than for controls (29 vs 10 days, P < .001). The hospital charges for bacterial infections (n = 161) and mycotic infections (n = 154) were significantly greater than their matched control population ($107 734 and vs $60 716 and $102 541 vs $67 016, respectively, P < .001 for both). CONCLUSIONS The development of septicemia after cystectomy predicts for patient mortality. Septicemia, bacterial infections, and mycotic infections contribute to large increases in the length of stay and total hospital charges. UROLOGY 73: 598-602, 2009. (C) 2009 Elsevier Inc.