Predicting perioperative mortality after radical cystectomy: comorbidity assessment tools are only part of the puzzle

A radical cystectomy (RC) is the mainstay of treatment for patients with muscle invasive bladder cancer (MIBC) (1). Despite improvements in surgical techniques and peri-operative management, the incidence of complications after RC remains significant. Even in contemporary series the incidence of grade 3–5 complications within 90 days after RC is high and occurs in up to 19% of the patients (2). The reported 90-day mortality rate varies between 1.2% and 8% (3,4).