Perioperative Outcomes of Enterocystoplasty in Adults
Valary T. Raup, MD; Pamela W. Lu, MD; Bjoern Loeppenberg, MD; Christian Meyer, MD; Malte Vetterlein, MD; Quoc-Dien Trinh, MD; Jairam Eswara, MD
Brigham and Women's Hospital, Harvard Medical School, Boston, MA
BACKGROUND: Enterocystoplasty has been used to treat neurogenic bladder in both children and adults. While this procedure has been well-studied in children, the literature for adult patients is lacking. In this study, we examined the perioperative outcomes of adult enterocystoplasty.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2007-2012) was queried using Current Procedural Terminology (CPT) codes for bladder augmentation (51960). Medical comorbidities, length of stay (LOS), operative time (OT), 30-day complications (including infectious, thromboembolic, renal, cardiac, pulmonary, and neurologic events), and need for blood transfusion, re-intubation, or reoperation were analyzed. Prolonged OT and LOS were defined as an operating time and a hospital length-of-stay of 75th percentile or greater, respectively (pOT=6.6 hours and pLOS= 8 days).
RESULTS: 42 patients having undergone enterocystoplasty were identified, with a median age at time of surgery of 47 years (17-73). Of these patients, 23 were female (54.7%), 12 were either paraplegic or quadraplegic (28.6%), and 13 were dependent upon caretakers to accomplish activities of daily living (ADLs) (30.9%). Nine patients underwent concurrent ileovesicostomy creation (21.4%). Median OT was 5.2 hours (310 minutes) and median LOS was 7 days. Nine patients developed post-operative complications within 30 days (21.4%), two of whom developed multiple complications (4.8%). Complications included superficial skin infections (4, 9.5%), organ space infections (1, 2.4%), sepsis (2, 4.8%), urosepsis (4, 9.5%), DVT (1, 2.4%), and PE (1, 2.4%). Three patients required blood transfusion (7.1%), and 3 required re-operation (7.1%). There were no 30-day postoperative mortalities. On univariate analysis, superficial skin infection was found to be associated with prolonged OT (0.0196) and dependence upon a caretaker (p=0.0451). No other significant associations were found.
CONCLUSIONS: Enterocystoplasty is a generally safe procedure, with no perioperative mortalities and few patients requiring reoperation or blood transfusions. This operation appears to be equally safe in patients with functional limitations, and concurrent ileovesicostomy was not associated with futher complications. Every effort should be made to decrease operative time to avoid the formation of superficial wound infections, and optimal wound care should be established in patients dependent upon a caretaker.
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