Background: Radical cystectomy is associated with considerable postoperative morbidities. Enhanced recovery after surgery protocol is a multimodal perioperative pathway implemented to improve post-surgical outcomes over the past decade. We sought to compare the 30- and 90-day postoperative morbidity and mortality rates following RC and ileal conduit urinary diversion between 2000-2010 and 2010-2020 to evaluate the trends in patient outcomes and areas that need improvement. Methods: This retrospective cohort study used data from TriNetX US Collaborative network which allowed access to de-identified patient health records from over 43 healthcare organizations. ICD-10 codes were used to identify patients with bladder cancer who underwent radical cystectomy and ileal conduit urinary diversion from 01/01/2000 to 01/01/2020. The rates of 30 and 90-day postoperative morbidities and mortalities were compared between 2000 – 2010 and 2010 – 2020 using the chi-squared test. Results: The 30 and 90-day complications by decade were summarized in Table. There were 738 cases reported from 22 HCOs from 2000 to 2010 and 10,052 cases reported from 43 HCOs from 2010 to 2020. The overall all-cause mortality at 30 and 90-days postop were 1.5% and 4.4%, respectively, and remain unchanged over the past 20 years. The most common complications within 90-days postop were urosepsis (19.1%), acute kidney injury (16.3%), and UTI (15.6%). While most complication rates remain stable, the rates of urosepsis, acute kidney injury, and UTI were higher between 2010 to 2020 compared to 2000 to 2010. Conclusions: Radical cystectomy and urinary diversion procedure is associated with high perioperative morbidities with up to 1 in 5 patients experiencing a complication within 90-days postop. Despite reported improvement in cancer-specific survivals from recent reports, the overall morbidity and mortality rates associated with the procedure have not improved over the past two decades. Further research is needed to improve surgical outcomes, especially in infectious complication and renal function, for patients with bladder cancer undergoing radical cystectomy.

*Discrepancy due to timeline limitations and cohort size in TriNetX dataset.