Background: To test for differences in complication rates, in-hospital mortality, length of stay (LOS) and total hospital costs (THCs) in patients treated with neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC). Methods: Within the National (Nationwide) Inpatient Sample (NIS) database (2016−2019), we identified RC-treated, non-metastatic, lymph-node negative bladder cancer patients, stratified by NAC status. Trend analyses, multivariable logistic, multivariable Poisson and multivariable linear regression models were used. Results: We identified 4347 RC-treated bladder cancer patients. Of those, 805 (19%) received NAC prior to RC. Overall, complications rates did not differ (65 vs. 66%; p = 0.7). However, NAC patients harbored lower rates of surgical site (6 vs. 9%), cardiac (13 vs. 19%) and genitourinary (5.5 vs. 9.7%) complications. In-hospital mortality (<1.7 vs. 1.8%) and LOS (6 vs. 7 days) was lower in NAC patients (all p < 0.05). Moreover, NAC was an independent predictor of shorter LOS in multivariable Poisson regression models (Risk ratio: 0.86; p < 0.001) and an independent predictor for higher THCs in multivariable linear regression models (Odds ratio: 1474$; p = 0.02). Conclusion: NAC was not associated with higher complication rates and in-hospital mortality. Contrary, NAC was associated with shorter LOS, yet moderately higher THCs. The current analysis suggests no detriment from NAC in the context of RC.

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal QC H4A 3J1 Canada

Department of Maternal Child and Urological Sciences Sapienza Rome University Policlinico Umberto 1 Hospital 00185 Rome Italy

Department of Surgical and Diagnostic Integrated Sciences University of Genova 16132 Genova Italy

Department of Urology 2nd Faculty of Medicine Charles University 128 08 Prague Czech Republic

Department of Urology Comprehensive Cancer Center Medical University of Vienna 1090 Vienna Austria

Department of Urology Koc University Hospital Istanbul 34450 Turkey

Department of Urology University Hospital Frankfurt Goethe University Frankfurt am Main 60596 Frankfurt am Main Germany

Department of Urology University Hospital Hamburg Eppendorf 20246 Hamburg Germany

Department of Urology University of Texas Southwestern Dallas TX 75390 USA

Department of Urology University of Verona Azienda Ospedaliera Universitaria Integrata di Verona 37134 Verona Italy

Department of Urology Weill Cornell Medical College New York NY 10021 USA

Division of Experimental Oncology Unit of Urology URI Urological Research Institute IRCCS San Raffaele Scientific Institute 20132 Milan Italy

Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman 19328 Jordan

Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University 119992 Moscow Russia

Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf 20251 Hamburg Germany

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