51 DOWNSTREAM CONSEQUENCES OF URINARY DIVERSION

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 201051 DOWNSTREAM CONSEQUENCES OF URINARY DIVERSION John L. Gore, Scott M. Gilbert, Julie Lai, and Christopher S. Saigal John L. GoreJohn L. Gore Seattle, WA More articles by this author , Scott M. GilbertScott M. Gilbert Gainesville, FL More articles by this author , Julie LaiJulie Lai Santa Monica, CA More articles by this author , and Christopher S. SaigalChristopher S. Saigal Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.097AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surveillance following urinary diversion should capture complications downstream from the initial reconstruction. Most analyses of the morbidity of urinary diversion are restricted to the index admission or the immediate postoperative period. We sought to characterize the long-term complications and burden of healthcare utilization following urinary diversion. METHODS Using the 5% Medicare sample from 1997–2007, we identified individuals undergoing cutaneous and orthotopic neobladder, ileal conduit urinary diversion, and other diversion including enterocystoplasty from physician claims for the index admission. We restricted our sample to subjects with claims 1 year prior to surgery and at least 2 years after the diversion. We included benign and malignant primary diagnoses, and evaluated the incidence of complications 2 and 5 years after surgery. We stratified complications by diversion type, and compared healthcare utilization after surgery with control groups of non-diverted bladder cancer patients (BC, n = 20,479) and patients undergoing colectomy (n = 37,042). RESULTS Of 1,565 subjects identified, 80% underwent ileal conduit urinary diversion, 7% underwent cutaneous or orthotopic neobladder, and 13% underwent other types of reconstruction. Table 1 lists 2 and 5-year complication rates by diversion type. Neobladder subjects had higher rates of other wound complications and urinary stone formation 2 and 5 years after diversion. Fistula formation 5 years after surgery was likewise significantly higher in the neobladder group. Compared with the BC and colectomy cohorts, diversion subjects had more hospital readmissions (56% vs 41% and 53%, respectively, p<0.001, in year 1, 38% vs 31% for both, p<0.001 in year 2) and ER visits (2.1 ± 3.2 vs 1.5 ± 2.5 and 1.7 ± 2.7, respectively, p<0.001) in the 24 months after surgery. Table1. Complication rates 2 and 5 years after urinary diversion. Diversion type p-value Ileal conduit Neobladder Other 2-year complication rates, no. (%) Total 1,248(80) 105(7) 212(13) Infection 14(1) 1(1) 4(2) 0.62 Stomal 50(4) 4(4) 6(3) 0.72 Hernia 77(6) 5(5) 8(4) 0.34 Other wound 134(11) 13(12) 11(5) 0.03 Urinary obstruction 149(12) 6(6) 29(14) 0.11 Urinary stones 22(2) 6(6) 4(2) 0.02 Fistula formation 36(3) 3(3) 11(5) 0.21 5-year complication rates, no. (%) Total 544(78) 56(8) 94(14) Infection 11(2) 2(4) 2(2) 0.75 Stomal 35(6) 5(9) 7(7) 0.75 Hernia 58(11) 8(14) 9(10) 0.65 Other wound 104(19) 19(34) 17(18) 0.03 Urinary obstruction 95(17) 7(13) 15(16) 0.62 Urinary stones 21(4) 7(13) 4(4) 0.01 Fistula formation 20(4) 6(11) 7(7) 0.03 CONCLUSIONS Complications are common after urinary diversion and continue to occur through 5 years postoperatively. Neobladder patients are at higher risk for urolithiasis and delayed wound complications than those undergoing other urinary diversions. Regardless of diversion type, healthcare utilization after urinary diversion is high. Further investigation is warranted to understand patient and provider factors associated with late complications and increased healthcare utilization after urinary diversion. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e21-e22 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information John L. Gore Seattle, WA More articles by this author Scott M. Gilbert Gainesville, FL More articles by this author Julie Lai Santa Monica, CA More articles by this author Christopher S. Saigal Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...