MP65-01 RISK FACTORS FOR PARASTOMAL HERNIATION: A SURVEILLANCE, EPIDEMIOLOGY AND END RESULTS-MEDICARE DATA ANALYSIS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP65-01 RISK FACTORS FOR PARASTOMAL HERNIATION: A SURVEILLANCE, EPIDEMIOLOGY AND END RESULTS-MEDICARE DATA ANALYSIS Diboro Kanabolo, Sarah Holt, Jonathan Wright, and George Schade Diboro KanaboloDiboro Kanabolo More articles by this author , Sarah HoltSarah Holt More articles by this author , Jonathan WrightJonathan Wright More articles by this author , and George SchadeGeorge Schade More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A frequent complication of stoma creation is parastomal herniation (PSH), defined as any palpable bulge or radiologic defect containing bowel in the parastomal region. Reported incidence rates are up to 50% for patients in the 24 months following ileal conduit (IC) surgery. To better understand risk factors for PSH in those undergoing cystectomy and ileal conduit (RC/IC) procedure, we examined a contemporary cohort of patients through combined Surveillance, Epidemiology and End Results-Medicare data (SEER-MD). METHODS: Using SEER-MD, patients with PSH after cystectomy and IC were identified. This was performed using CPT codes to identify surgery patients and subsequent diagnostic the new ICD-10 PSH specific code (K43.5) post-surgery, for those with surgery between 2015 and 2019. Risk factors of interest included: race, sex, socioeconomic status, marital status, COPD, smoking, obesity status, neoadjuvant chemotherapy administration, and tumor stage. An adjusted Cox Proportional-Hazards model was utilized for statistical analysis, enabling assessment of time to PSH from receipt of surgery and to account for censored patients. RESULTS: Of 1,838 patients identified as having undergone RC/IC, 132 patients (7 %) developed PSH in the followup period. The median time to PSH was 11.5 months (IQR: 6.5-18.7 months). The greatest risk factor in our cohort of patients for development of PSH was obesity (HR 2.05, 95% CI 1.48-2.98). The lowest socioeconomic quartile was also associated with greater risk of PSH (HR 1.49, 95% CI 1.01-2.22). Sex, COPD diagnosis, gender, race, smoking status, neoadjuvant chemotherapy, and tumor stage were not significantly associated with risk of PSH, although the female sex, Black/Hispanic race, and pT4 lesions showed elevated HR estimates. Marital status of “Divorced/Separated/Widowed” was significantly associated with PSH (HR 1.66, 95% CI 1.04-2.66) vs. “Married”, however due to a large portion of “unknown” marital status in our cohort, this finding may not be clinically meaningful. CONCLUSIONS: While the SEER-MD incidence rate is far below 50%, this reflects a mutable coding process subject to variation in capture by provider. With the available cohort, our model demonstrated an increased risk of PSH for obese and low SES patients undergoing RC/IC surgery. Both weight loss prevention strategies and careful symptom monitoring must be pursued in this population. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e890 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Diboro Kanabolo More articles by this author Sarah Holt More articles by this author Jonathan Wright More articles by this author George Schade More articles by this author Expand All Advertisement PDF downloadLoading ...