MP60-14 TRENDS IN URINARY DIVERSION AMONG PATIENTS UNDERGOING RADICAL CYSTECTOMY: A CONTEMPORARY POPULATION-BASED ANALYSIS

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2014MP60-14 TRENDS IN URINARY DIVERSION AMONG PATIENTS UNDERGOING RADICAL CYSTECTOMY: A CONTEMPORARY POPULATION-BASED ANALYSIS Jeffrey Leow, Joaquim Bellmunt, Benjamin Chung, and Steven Chang Jeffrey LeowJeffrey Leow More articles by this author , Joaquim BellmuntJoaquim Bellmunt More articles by this author , Benjamin ChungBenjamin Chung More articles by this author , and Steven ChangSteven Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1768AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The type of urinary diversion performed after radical cystectomy (RC) depends on a variety of factors including tumor location, performance status, patient preferences, and surgeon competence. We aim to describe contemporary trends in urinary diversion among RC patients in the United States. Methods Using the Premier Comparative Database (Premier, Inc., Charlotte, NC), which collects data from over 600 non-federal hospitals throughout the US, we captured all patients who underwent a RC (ICD-9 code 57.71). Continent neobladder reconstruction was captured using ICD-9 code 57.87 and incontinent ileal/colonic conduit using 56.51, 56.61 and 56.71. Utilization of continent diversion was trended by year. Multivariable analyses incorporating relevant patient, hospital and surgical factors were performed after adjusting for survey weighting and clustering to evaluate the relationship between hospital and patient characteristics and the use of continent urinary diversion. Results The final cohort had 42635 RCs, of which 2627 (6.2%) and 40009 (93.8%) were continent and incontinent urinary diversions. There was no significant increase in use of continent diversion from 2003 (5.6%) to 2010 (5.3%). Predictors of receipt of continent diversion include private insurance (OR: 2.01, p<0.01), receipt of pelvic lymphadenectomy (OR: 2.07, p<0.01), and higher surgeon volume (OR: 2.27, p<0.01). Patients who are older, female, and have worse Charlson comorbidity scores are less likely to have continent diversions (Table 1). The use of robotic surgery had no association with the type of urinary diversion. Conclusions The use of continent diversion appears to have remained stable at about 6% in recent years. Significant variations in urinary diversion appear to exist by insurance status and surgeon volume/technique. No hospital factors nor the adoption of robotic radical cystectomy has altered the use of continent urinary diversion. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e638 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jeffrey Leow More articles by this author Joaquim Bellmunt More articles by this author Benjamin Chung More articles by this author Steven Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...