A COMPARATIVE ANALYSIS OF COMPLICATION RATES IN URINARY DIVERSIONS: EXPLORING THE IMPACT OF CONTEMPORARY SURGICAL TRENDS

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2025-03-01 DOI:10.1016/j.urolonc.2024.12.030

John Pfail, Alain Kaldany, Rachel Passarelli, Melinda Fu, Benjamin Lichtbroun, Kevin Chua, Vignesh Packiam, David Golombos, Thomas Jang, Saum Ghodoussipour

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Abstract

Introduction

Historically, outcomes have been similar among patients undergoing continent and incontinent diversion at time of radical cystectomy, with no difference in complication rates. Given the decreasing rates of continent diversion, we sought to examine postoperative complication rates based on type of diversion in a contemporary cohort.

Methods

Data was extracted from the National Surgical Quality Improvement Program (NSQIP) database including all patients from 2019-2021 who underwent radical cystectomy. Patients were stratified based on diversion type. Statistical endpoints included thirty-day complications, length of stay (LOS), and readmissions. Optimal RC outcome was defined as absence of any postoperative complication, reoperation, prolonged LOS (75th percentile, 8 days) with no readmission. Multivariable analyses with Bonferroni correction were performed to assess the association between urinary diversion and postoperative outcomes in patients undergoing RC.

Results

A total of 4375 patients were identified, including 3780 (86.4%) who underwent incontinent diversion and 595 (13.6%) who underwent continent diversion. Compared to patients with continent diversion, those with incontinent diversion were more likely to be older, female, have higher ASA, worse renal function, robotic/laparoscopic approach, history of radiation or pelvic surgery, and higher stage (Table 1). On multivariable analysis, after Bonferroni adjustment, patients with continent diversion had increased odds of high grade complications (OR 1.58; 99% CI [1.15-2.15]) and readmission (OR 1.7 [1.28-2.27]) as well as lower odds of an optimal outcome (OR 0.74 [0.58-0.95]) compared to incontinent diversion (Figure 1).

Conclusions

In a contemporary cohort of patients undergoing radical cystectomy, odds of adverse postoperative outcomes were increased among those undergoing continent diversion compared to incontinent diversion, despite more favorable baseline characteristics in this cohort.

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尿改道并发症发生率的比较分析：探讨当代手术趋势的影响

从历史上看，在根治性膀胱切除术时进行失禁和失禁转移的患者的结果相似，并发症发生率没有差异。鉴于大陆分流率的下降，我们试图在当代队列中检查基于分流类型的术后并发症发生率。方法数据取自美国国家手术质量改进计划（NSQIP）数据库，包括2019-2021年接受根治性膀胱切除术的所有患者。根据分流类型对患者进行分层。统计终点包括30天并发症、住院时间（LOS）和再入院。最佳RC结果定义为无任何术后并发症，再手术，延长LOS（75百分位，8天），无再入院。采用Bonferroni校正的多变量分析来评估RC患者尿分流与术后预后之间的关系。结果共纳入4375例患者，其中尿失禁分流3780例（86.4%），尿失禁分流595例（13.6%）。与大陆分流患者相比，失禁分流患者更可能是年龄较大、女性、ASA较高、肾功能较差、机器人/腹腔镜入路、放疗或盆腔手术史以及分期较高（表1）。在多变量分析中，经Bonferroni调整后，大陆分流患者出现高级别并发症的几率增加(or 1.58；99% CI[1.15-2.15])和再入院（OR为1.7[1.28-2.27]），以及与失禁转移相比获得最佳结果的几率更低（OR为0.74[0.58-0.95]）（图1）。结论在一个接受根治性膀胱切除术的当代患者队列中，尽管该队列的基线特征更有利，但与失禁转移相比，接受失禁转移的患者术后不良结果的几率增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.