Ileal Conduit versus Continent Urinary Diversion in Radical Cystectomy: An Analysis of 30-day NSQIP Outcomes
Michael Rezaee, MD, MPH1, William Bihrle, MD2, Florian R. Schroeck, MD, MS2, Johnd D. Seigne, MB2.
1Johns Hopkins Medicine, Baltimore, MD, USA, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
BACKGROUND: Continent urinary diversion at the time of radical cystectomy can provide patients with a more cosmetically pleasing and functionally normal lower urinary tract, but potentially at the cost of worse perioperative outcomes. The purpose of this study was to quantify the short-term burden associated with continent diversion relative to ileal conduit creation.
METHODS: Patients who underwent radical cystectomy in 2019 and 2020 were identified in the American College of Surgeons National Surgical Improvement Program database using current procedural terminology codes. Patients were grouped by type of urinary diversion performed: ileal conduit versus continent diversion (neobladder or cutaneous pouch). Multiple logistic regression was used to examine the association between type of urinary diversion and 30-day outcomes, including post-operative complications, all-cause readmissions, and mortality.
RESULTS: Of 4,951 patients who underwent radical cystectomy, 714 underwent continent diversion (14.4%). These patients were significantly younger (61.8 vs. 69.6 years, p<0.01) and less likely to have diabetes (14.2% vs. 20.2%, p <0.01), malnourishment (1.8% vs. 4.0%, p <0.01), or a history of prior pelvic radiation (5.2% vs. 13.1%, p<0.01) or surgery (45.8% vs. 51.5%, p<0.01). A greater proportion of continent diversion patients experienced a post-operative complication (54.6% vs. 47.4%, p<0.01) or readmission to the hospital (30.3% vs. 20.2%, p<0.01). After adjustment, continent diversion patients had 1.5 (95% CI 1.2-1.8) and 1.8 (95% CI: 1.5-2.2) the odds of experiencing a post-operative complication or readmission to the hospital, respectively. Mortality did not differ between continent and ileal conduit urinary diversion patients (0.8% vs. 1.7%, p=0.1).
CONCLUSIONS: Compared to ileal conduit creation, continent urinary diversion is associated with a greater likelihood of post-operative complications and readmission to the hospital within 30 days of surgery. Cystectomy patients seeking continent diversion should be thoroughly counseled on the increased short-term morbidity associated with this specific type of diversion.
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