PD9-09 ANALYSIS OF PERIOPERATIVE OUTCOMES FOR PROCEDURES INVOLVING URINARY DIVERSION USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion I1 Apr 2015PD9-09 ANALYSIS OF PERIOPERATIVE OUTCOMES FOR PROCEDURES INVOLVING URINARY DIVERSION USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE Robert C. Kovell, David C. Brooks, Devin A. Haddad, Ahmed A. Aboumohamed, and Ryan P. Terlecki Robert C. KovellRobert C. Kovell More articles by this author , David C. BrooksDavid C. Brooks More articles by this author , Devin A. HaddadDevin A. Haddad More articles by this author , Ahmed A. AboumohamedAhmed A. Aboumohamed More articles by this author , and Ryan P. TerleckiRyan P. Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.936AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgeries requiring urinary diversion have been associated with high rates of perioperative morbidity and mortality. Understanding factors that contribute to the risks of these surgeries is important for improving surgical outcomes and properly counseling patients. METHODS Using the National Surgical Quality Improvement Program (NSQIP) database, we identified patients undergoing urinary diversion using a bowel segment, with or without cystectomy, performed between 2010 and 2012. We compared preoperative characteristics, surgical parameters and 30-day postoperative outcomes. We stratified patients based on the continence status of the diversion, incontinent (ID) v continent (CD). Statistical significance was assessed using chi square, t-test and ANOVA. RESULTS We identified 1959 urinary diversions in the NSQIP database: 1568 IDs (80.0%) and 391 CDs (20.0%). Concomitant cystectomy was performed with 1468 (93.6%) IDs and 374 (95.7%) CDs. Among various preoperative characteristics analyzed, higher rates of COPD (4.4% v 9.1%), previous cardiac surgery (1.8% v 4.3%), HTN (47% v 63%), and metastatic cancer (2.1% v 4.7%) were associated with patients undergoing ID. Pre-operative creatinine levels were higher in patients undergoing ID (1.08 v 1.19 mg/dL). CD patients were more likely to have undergone pre-operative chemotherapy (10.5% v 5.5%). Operative time was longer for CDs (388 min v 336 min). Post-operative UTI (13.8% v 7.9%) and sepsis rates (11.5% v 7.9%) were significantly higher in CDs, whereas transfusion rates were higher with IDs (37.1% v 45.2%). No differences were observed in the rates of thromboembolic events or postoperative renal insufficiency. Thirty day readmission rates (18.2% v 15.5%), length of stay (10.2 v 10.7 days), occurrence of any NSQIP captured complication (57.5% v 60.1%) and mortality (1.5% v 2.1%) were not statistically different between CD and ID. CONCLUSIONS Surgeries involving urinary diversion continue to have significant morbidity. While continent diversion offers patients a number of long term advantages, these must be balanced against longer operative times and higher rates of post-operative infectious complications. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e198 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert C. Kovell More articles by this author David C. Brooks More articles by this author Devin A. Haddad More articles by this author Ahmed A. Aboumohamed More articles by this author Ryan P. Terlecki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...