PD44-07 BOWEL PREPARATION REGIMENS WITH REDUCE SEPSIS FOLLOWING RADICAL CYSTECTOMY WITH CONTINENT DIVERSION

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD44-07 BOWEL PREPARATION REGIMENS WITH REDUCE SEPSIS FOLLOWING RADICAL CYSTECTOMY WITH CONTINENT DIVERSION Rishabh Simhal, Maria Poluch, Yash Shah, Kerith Wang, Joon Yau Leong, Mihir Shah, Leonard Gomella, Thenappan Chandrasekar, and Costas Lallas Rishabh SimhalRishabh Simhal More articles by this author , Maria PoluchMaria Poluch More articles by this author , Yash ShahYash Shah More articles by this author , Kerith WangKerith Wang More articles by this author , Joon Yau LeongJoon Yau Leong More articles by this author , Mihir ShahMihir Shah More articles by this author , Leonard GomellaLeonard Gomella More articles by this author , Thenappan ChandrasekarThenappan Chandrasekar More articles by this author , and Costas LallasCostas Lallas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003354.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bowel preparation regimens (BRs) were historically standard before radical cystectomy (RC) with urinary diversion to decrease infection and anastomotic breakdown. However, the Enhanced Recovery After Surgery protocol (ERAS) no longer includes BRs. Recent data show that BRs may exacerbate frailty, worsen surgical outcomes, and prolong recovery. Importantly, however, previous studies did not stratify by diversion type. We performed a population-based analysis of preoperative oral antibiotic BRs (OABRs) with RC, alongside subgroup analyses to compare outcomes by diversion type. METHODS: RCs performed from 2019-2020 were identified using the new NSQIP Cystectomy-Targeted PUF. Captured variables included OABR, diversion type, demographics, comorbidities, and perioperative outcomes. Univariate analysis with two tailed chi square and t tests was performed to compare baseline characteristics, 30-day mortality, and complications. Multivariable logistic regression with stepwise-backward-elimination (p>0.25) adjusted for mechanical BRs, operative approach, comorbidities, functional status, demographics, ASA class, labs, and staging. RESULTS: In total, 3,894 RCs were performed, of which 357 (9.2%) included OABR. There were no significant baseline differences between the OABR and the non-OABR cohorts. On univariate analysis, OABR patients had increased operative time, length of stay (LOS), minor complications, and bleeds. On subgroup analysis, ileal conduit patients experienced higher rates of the 4 aforementioned outcomes plus deep wound infections and NGT use. However, the continent diversion subgroup was not associated with increased operative time, LOS, or any complications. Continent diversion had significantly lower rates of sepsis and ureteral fistula formation. Upon multivariable adjustment, OABR was not associated with increased rates of any complications across any subgroup. OABR did confer significantly decreased odds of sepsis in continent diversion patients. CONCLUSIONS: Supporting ERAS recommendations, this study showed that pre-RC OABRs do not improve outcomes and increase LOS for ileal conduits. However, this study uniquely included continent diversions, such as neobladders and Indiana pouches. Importantly, in continent diversion patients, OABR did not increase LOS or complications while decreasing sepsis rates. These findings suggest possible utility of OABR before RC with continent diversion. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1127 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rishabh Simhal More articles by this author Maria Poluch More articles by this author Yash Shah More articles by this author Kerith Wang More articles by this author Joon Yau Leong More articles by this author Mihir Shah More articles by this author Leonard Gomella More articles by this author Thenappan Chandrasekar More articles by this author Costas Lallas More articles by this author Expand All Advertisement PDF downloadLoading ...