PD12-01 A NATIONAL ANALYSIS OF PERIOPERATIVE OUTCOMES FOR REVISION OF A URETEROENTERIC ANASTOMOSIS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I1 Apr 2016PD12-01 A NATIONAL ANALYSIS OF PERIOPERATIVE OUTCOMES FOR REVISION OF A URETEROENTERIC ANASTOMOSIS Joseph J. Pariser, Shane M. Pearce, Vignesh T. Packiam, Norm D. Smith, Gary D. Steinberg, and Gregory T. Bales Joseph J. PariserJoseph J. Pariser More articles by this author , Shane M. PearceShane M. Pearce More articles by this author , Vignesh T. PackiamVignesh T. Packiam More articles by this author , Norm D. SmithNorm D. Smith More articles by this author , Gary D. SteinbergGary D. Steinberg More articles by this author , and Gregory T. BalesGregory T. Bales More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.896AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stricture of the ureteroenteric anastomosis is a complication after cystectomy with urinary diversion. Relatively little has been reported on the perioperative course during surgical repair of a ureteroenteric anastomosis. Adhesions can increase the risk of bowel injury and necessitate concomitant bowel repair. We hypothesized that the need for concomitant bowel surgery during revision of a ureteroenteric anastomosis is associated with adverse perioperative outcomes. METHODS The National Inpatient Sample (2002-2012) was used to identify patients requiring revision of ureteroenteric anastomosis, excluding patients <18 years and procedures with concomitant renal transplant or cystectomy. Demographic, clinical and hospital factors were examined. Comparisons were made between patients who did and did not require concomitant bowel surgery. Multivariate logistic regression was used to identify factors associated with 1) concomitant bowel surgery and 2) complications. RESULTS Of the 1,095 patients identified, the median age was 64 (IQR 55-71) and 29% patients were female. Overall, 383 (35%) underwent concomitant bowel surgery. There were no differences between patients requiring bowel surgery in terms of age, gender, race or comorbidity (all p>0.2). Overall complication rate was 50%, with 19% UTI, 17% bleeding and 3% venous thromboembolism. Of these, only overall complications (65% vs 41%, p<0.01) and bleeding (28% vs 11%, p=<0.01) were higher for patients undergoing bowel surgery. Patients who underwent bowel surgery also experienced longer length of stay [12 days (IQR 8-19) vs 6 (IQR 4-8)] and inpatient charges than those who did not (p<0.01 for both). Overall inpatient mortality rate was 1.2%, with no difference based on receipt of bowel surgery (p=0.09). On multivariate analysis, there were no identifiable factors predictive for the need for bowel surgery (all p>0.1). Undergoing concomitant bowel surgery (OR 2.8 [1.2-6.2], p=0.02) was the only independent risk factor for complications during ureteral reimplantation after controlling for demographics, clinical and hospital characteristics. CONCLUSIONS Reimplantation of a ureteroenteric anastomosis was associated with a 50% complication rate. There were no demographic or clinical factors associated with need for concomitant bowel surgery, which was necessary in 35% of patients. Undergoing a concomitant bowel procedure was an independent predictor for perioperative complications. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e293 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Joseph J. Pariser More articles by this author Shane M. Pearce More articles by this author Vignesh T. Packiam More articles by this author Norm D. Smith More articles by this author Gary D. Steinberg More articles by this author Gregory T. Bales More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...