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Socioeconomic status is associated with urinary diversion utilization after radical cystectomy for bladder cancer

  • Urology – Original Paper
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Abstract

Purpose

To assess socioeconomic disparities in urinary diversion utilization in a contemporary American cohort.

Methods

In the National Cancer Database, we identified 4538 patients who underwent cystectomy with urinary diversion for clinical T1-2N0M0 bladder cancer from 2010 to 2013. Multivariable logistic regression was used to identify predictors of urinary diversion type: ileal conduit (IC), continent cutaneous reservoir (CCR), or orthotopic neobladder (ON). Covariates included age, gender, race, income, Charlson score, clinical T stage, hospital cystectomy volume, teaching status, and surgical approach. Subgroup analysis by hospital volume (low, intermediate, or high) and teaching status (academic or non-academic) was performed to ascertain the impact of regionalization on urinary diversion use.

Results

The final cohort included 4066 (89.6 %) patients with IC, 292 (6.4 %) with CCR, and 180 (4.0 %) with ON. On multivariable analysis, younger age (p < .01), higher income (p < .01), and high cystectomy volume predicted increased use of CCR and ON. Female gender predicted increased use of CCR versus IC (p < .01), and academic hospital status predicted increased use of ON versus IC (p = .04). On subgroup analysis, after further adjustment for hospital volume and teaching status, higher income remained an independent predictor of ON use.

Conclusions

Despite regionalization of care, higher income patients are more likely to receive complex urinary diversions after radical cystectomy. Other related socioeconomic factors, especially patient education, may influence this practice pattern.

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Acknowledgments

We deny any financial or material research support for this work.

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Authors and Affiliations

  1. Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Matthew J. Maurice

  2. Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Office 4565, Mailstop LKS 5046, Cleveland, OH, 44106, USA

    Simon P. Kim & Robert Abouassaly

Authors
  1. Matthew J. Maurice
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  2. Simon P. Kim
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  3. Robert Abouassaly
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Corresponding author

Correspondence to Robert Abouassaly.

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Conflict of interest

We deny any potential direct or indirect conflicts of interest.

Disclaimer

The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

Electronic supplementary material

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Supplementary Table 1

Predictors of urinary diversion taking into account patient education. CCI = Charlson comorbidity index; CCR = continent cutaneous reservoir; IC = ileal conduit; ON = orthotopic neobladder. (DOCX 32 kb)

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Maurice, M.J., Kim, S.P. & Abouassaly, R. Socioeconomic status is associated with urinary diversion utilization after radical cystectomy for bladder cancer. Int Urol Nephrol 49, 77–82 (2017). https://doi.org/10.1007/s11255-016-1422-9

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  • DOI: https://doi.org/10.1007/s11255-016-1422-9

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