Morbidity Associated with Urinary Diversion in the United States: A Contemporary Evaluation Using the NSQIP Database

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Abstract

Introduction:

We identified preoperative differences between patients undergoing incontinent vs continent diversion, and compared 30-day complication outcomes between the 2 procedures.

Methods:

Using the NSQIP® (National Surgical Quality Improvement Program) database we identified patients undergoing urinary diversion incorporating bowel, with or without cystectomy, between 2010 and 2012. We compared preoperative characteristics, surgical parameters and 30-day postoperative outcomes. We stratified patients based on the continence status of the diversion as incontinent vs continent.

Results:

We identified 1,959 urinary diversions in the NSQIP database, including 1,568 incontinent diversions (80.0%) and 391 continent diversions (20.0%). Significantly higher rates of chronic obstructive pulmonary disease (9.1% vs 4.3%), previous cardiac surgery (4.3% vs 1.8%), hypertension (63.3% vs 47.1%) and disseminated disease (4.7% vs 2.1%) were noted in patients undergoing incontinent diversion. Patients undergoing continent diversion were significantly more likely to have received preoperative chemotherapy (10.5% vs 5.2%). Operative time was longer for continent diversion (388 vs 336 minutes). Postoperative urinary tract infection (13.8% vs 7.9%) and sepsis rates (11.5% vs 7.9%) were significantly higher with continent diversion, whereas transfusion rates were higher with incontinent diversion (45.2% vs 37.1%). Thirty-day readmission rates (18.2% vs 15.6%), length of stay (10.2 vs 10.7 days), presence of at least 1 NSQIP captured complication (61.4% vs 64.0%) and mortality (1.5% vs 2.1%) were not statistically different between continent diversion and incontinent diversion.

Conclusions:

Urinary diversion incorporating bowel continues to carry a significant risk of postoperative morbidity. While continent diversion offers potential long-term advantages, these must be balanced against longer operative times and higher rates of postoperative infectious complications.

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