Abstract
ObjectiveTo determine whether use of an antibiotic-irrigating wound protector (AWP) reduces infectious complications after robotic radical cystectomy with extracorporeal urinary diversion (RCUD). MethodsA prospectively maintained bladder cancer database was queried for patients undergoing robotic RCUD at a tertiary referral center one year prior to implementing an AWP and one year after (2018–2020). All diversions were performed extra-corporally. 92 patients total. 46 consecutive patients using a traditional wound protector (TWP) and 46 consecutive with an AWP. Infections were classified as symptomatic urinary tract infection, blood stream infection, and surgical site infection. The incidence of infectious complications at 30- and 90-days were compared. ResultsBaseline patient characteristics between the 2 groups showed no statistically significant differences. The overall complication rate was 65.2% in the TWP group and 26.1% in the AWP group at 30-days, and 67.4% vs 30.4% at 90-days. Focusing on infections, the 30-day complication rate was 30.4% in the TWP group compared to 6.5% in the AWP group (P =.003). This pattern persisted at 90-days with 37.0% in the TWP group compared to 6.5% in the AWP group (P =.004). Most complications were symptomatic UTI and blood stream infections, 14/24 (58%), requiring parenteral antibiotic treatment. ConclusionWe provide preliminary data showing use of an AWP can reduce infectious complications after RCUD. While larger prospective studies are warranted, our findings are a significant step towards decreasing morbidity of an already highly morbid procedure.
Highlights
In 2020, 81,400 new cases of bladder cancer were diagnosed which accounted for 4.5% of all new cancer diagnoses [1]
A total of 92 patients were included in our study cohort. 46 consecutive cases prior to implementation of an antibiotic-irrigating wound protector (AWP) and 46 consecutive cases with an AWP
The 30-day infectious complication rate was 30.4% in the traditional wound protector (TWP) group compared to 6.5% in the AWP group (p=0.003)
Summary
In 2020, 81,400 new cases of bladder cancer were diagnosed which accounted for 4.5% of all new cancer diagnoses [1]. In the RAZOR trial, Parekh et al reported a 67% and 69% overall complication rate in the robotic and open groups respectively, with 60% of the complications being attributed to infections [3]. The downstream effect of this high complication rate in an elderly, co-morbid population cannot be understated as hospital readmission, additional procedures, and economic burden all negatively impact patient quality of life [5]. It is the goal of this study to determine whether use of an antibiotic-irrigating wound protector (AWP) can reduce infectious complications among patients undergoing robotic RCUD for bladder cancer
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