283 THE USE OF URINARY DIVERSION AND BLADDER AUGMENTATION IN PATIENTS WITH SPINAL CORD INJURY IN THE UNITED STATES; PROCEDURE SELECTION AND COST

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2012283 THE USE OF URINARY DIVERSION AND BLADDER AUGMENTATION IN PATIENTS WITH SPINAL CORD INJURY IN THE UNITED STATES; PROCEDURE SELECTION AND COST Andrew Peterson, Lesley Curtis, Alisa Shea, Kristy Borawski, Kevin Schulman, and Charles Scales Andrew PetersonAndrew Peterson Durham, NC More articles by this author , Lesley CurtisLesley Curtis Durham, NC More articles by this author , Alisa SheaAlisa Shea Durham, NC More articles by this author , Kristy BorawskiKristy Borawski Chapel Hill, NC More articles by this author , Kevin SchulmanKevin Schulman Durham, NC More articles by this author , and Charles ScalesCharles Scales Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.341AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder augmentation and urinary diversion are often utilized to manage the urologic problems associated with spinal cord injury. We sought to characterize the utilization of urinary diversion and augmentation in patients with spinal cord injury in the United States. METHODS The institutional review board determined this study exempt from the requirement for approval. Discharge estimates for 1998 to 2005 were derived from the Nationwide Inpatient Sample identifying those undergoing ileal loop urinary diversion (ICD-9-CM procedure code 56.51) or bladder augmentation (57.87) with a diagnostic code for spinal cord injury. We analyzed patient demographics, payer, hospital teaching status, length of stay, total charges and discharge status. We used SAS® statistical software version 9.1 to generate national estimates with an ultimate cluster variance model to account for the complex survey design of the NIS. Categorical outcomes were compared with the Rao-Scott chi-square test, and z tests to compare continuous outcomes. RESULTS A total of 3051 procedures were performed during the study period; 1919 ileal loop diversions (63%) and 1132 bladder augmentations (37%). Patients who underwent ileal diversions were older (46 years versus 34 years, p<0.001) than patients who underwent augmentation. Those undergoing diversion were most likely to have Medicare as the primary payer, but private insurance was the most common payer for augmentation (p<0.001). Patients who underwent diversion appeared to use more healthcare resources, with greater length of stay (15 days versus 9 days), higher hospital charges ($58, 626 versus $37, 222) and were more likely to require home health services upon discharge (all p<0.001). Those undergoing surgery at teaching institutions were more likely to undergo bladder augmentation (42%) than those at non-teaching institutions (23%, p<0.001). CONCLUSIONS Bladder augmentation is used in approximately one third of cases to manage the urologic complications of spinal cord injury. These patients likely form a clinically distinct population that uses fewer healthcare resources. Lower augmentation rates at non-teaching institutions may indicate an opportunity to optimize spinal cord injury care in the United States. In-hospital outcomes for patients with spinal cord injury undergoing urinary diversion procedures, Nationwide Inpatient Sample, 1998 to 2005. Ileal loop (56.51) Stderr Augmentation (57.87) Stderr P Value N 1919 1132 Length of stay (mean days) 15(1.0) 1.0 9(0.3) 0.3 <0.0001 Charges per discharge (mean) $58,626 2995 $37,222 1933 <0.0001 In hospital mortality ⁎ - ⁎ - 0.85 Discharge to home health 709(37%) 49.5 267(23.6%) 39.0 0.0002 Values are expressed as weighted percentages, unless otherwise indicated. ⁎ Too few discharges for reliable interpretation by Nationwide Inpatient Sample criteria. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e115 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Peterson Durham, NC More articles by this author Lesley Curtis Durham, NC More articles by this author Alisa Shea Durham, NC More articles by this author Kristy Borawski Chapel Hill, NC More articles by this author Kevin Schulman Durham, NC More articles by this author Charles Scales Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...