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Comparison of readmission and short-term mortality rates between different types of urinary diversion in patients undergoing radical cystectomy

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Abstract

Purpose

To analyze the impact of urinary diversion type following radical cystectomy (RC) on readmission and short-term mortality rates.

Methods

Patients who underwent RC for bladder cancer in the National Cancer Data Base were grouped based on the type of urinary diversion performed: non-continent [ileal conduit (IC)] or two continent techniques [continent pouch (CP) and orthotopic neobladder (NB)]. We used propensity score matching and multivariable logistic regression models to compare 30-day readmission and 30- and 90-day mortality between the different types of urinary diversion.

Results

Among 11,933 patients who underwent RC, we identified 10,197 (85.5%) IC, 1044 (8.7%) CP, and 692 (5.8%) NB. Patients who received IC were significantly older and had more comorbidities (p < 0.0001). Continent diversions were more likely to be performed at an academic center (p < 0.0001). Surgery performed at a non-academic center was an independent predictor of 30-day readmission (OR 1.19, p = 0.010) and 30-day mortality (OR 1.27, p = 0.043). Patients undergoing NB had an increased likelihood of being readmitted (OR 1.41, p = 0.010). There was no significant difference in short-term mortality between groups.

Conclusions

Patients undergoing NB had marginally increased rates of readmission compared to IC. Surgery performed at a non-academic center was associated with higher readmission and 30-day mortality. Similar short-term mortality rates were observed among the different types of urinary diversion.

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References

  1. Witjes JA, Comperat E, Cowan NC, De Santis M, Gakis G, Lebret T, Ribal MJ, Van der Heijden AG, Sherif A (2014) EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 65(4):778–792. https://doi.org/10.1016/j.eururo.2013.11.046

    Article  PubMed  Google Scholar 

  2. Malavaud B, Vaessen C, Mouzin M, Rischmann P, Sarramon J, Schulman C (2001) Complications for radical cystectomy. Impact of the American Society of Anesthesiologists score. Eur Urol 39(1):79–84. https://doi.org/10.1159/000052416

    Article  CAS  PubMed  Google Scholar 

  3. Gore JL, Saigal CS, Hanley JM, Schonlau M, Litwin MS (2006) Variations in reconstruction after radical cystectomy. Cancer 107(4):729–737. https://doi.org/10.1002/cncr.22058

    Article  PubMed  PubMed Central  Google Scholar 

  4. Collins JW, Patel H, Adding C, Annerstedt M, Dasgupta P, Khan SM, Artibani W, Gaston R, Piechaud T, Catto JW, Koupparis A, Rowe E, Perry M, Issa R, McGrath J, Kelly J, Schumacher M, Wijburg C, Canda AE, Balbay MD, Decaestecker K, Schwentner C, Stenzl A, Edeling S, Pokupic S, Stockle M, Siemer S, Sanchez-Salas R, Cathelineau X, Weston R, Johnson M, D’Hondt F, Mottrie A, Hosseini A, Wiklund PN (2016) Enhanced recovery after robot-assisted radical cystectomy: EAU robotic urology section scientific working group consensus view. Eur Urol. https://doi.org/10.1016/j.eururo.2016.05.020

    Google Scholar 

  5. Hautmann RE, de Petriconi RC, Volkmer BG (2011) 25 years of experience with 1,000 neobladders: long-term complications. J Urol 185(6):2207–2212. https://doi.org/10.1016/j.juro.2011.02.006

    Article  PubMed  Google Scholar 

  6. Parekh DJ, Donat SM (2007) Urinary diversion: options, patient selection, and outcomes. Semin Oncol 34(2):98–109. https://doi.org/10.1053/j.seminoncol.2006.12.010

    Article  PubMed  Google Scholar 

  7. Sogni F, Brausi M, Frea B, Martinengo C, Faggiano F, Tizzani A, Gontero P (2008) Morbidity and quality of life in elderly patients receiving ileal conduit or orthotopic neobladder after radical cystectomy for invasive bladder cancer. Urology 71(5):919–923. https://doi.org/10.1016/j.urology.2007.11.125

    Article  PubMed  Google Scholar 

  8. Porter MP, Penson DF (2005) Health related quality of life after radical cystectomy and urinary diversion for bladder cancer: a systematic review and critical analysis of the literature. J Urol 173(4):1318–1322. https://doi.org/10.1097/01.ju.0000149080.82697.65

    Article  PubMed  Google Scholar 

  9. Ali AS, Hayes MC, Birch B, Dudderidge T, Somani BK (2015) Health related quality of life (HRQoL) after cystectomy: comparison between orthotopic neobladder and ileal conduit diversion. Eur J Surg Oncol 41(3):295–299. https://doi.org/10.1016/j.ejso.2014.05.006

    Article  CAS  PubMed  Google Scholar 

  10. Antonelli A, Belotti S, Cristinelli L, De Luca V, Simeone C (2015) Comparison of perioperative morbidity of radical cystectomy with neobladder versus ileal conduit: a matched pair analysis of 170 patients. Clin Genitour Cancer. https://doi.org/10.1016/j.clgc.2015.07.011

    Google Scholar 

  11. Monn MF, Kaimakliotis HZ, Cary KC, Pedrosa JA, Flack CK, Koch MO, Bihrle R (2014) Short-term morbidity and mortality of Indiana pouch, ileal conduit, and neobladder urinary diversion following radical cystectomy. Urol Oncol 32(8):1151–1157. https://doi.org/10.1016/j.urolonc.2014.04.009

    Article  PubMed  Google Scholar 

  12. Kim SH, Yu A, Jung JH, Lee YJ, Lee ES (2014) Incidence and risk factors of 30-day early and 90-day late morbidity and mortality of radical cystectomy during a 13-year follow-up: a comparative propensity-score matched analysis of complications between neobladder and ileal conduit. Jpn J Clin Oncol 44(7):677–685. https://doi.org/10.1093/jjco/hyu051

    Article  PubMed  Google Scholar 

  13. Bilimoria KY, Stewart AK, Winchester DP, Ko CY (2008) The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 15(3):683–690. https://doi.org/10.1245/s10434-007-9747-3

    Article  PubMed  PubMed Central  Google Scholar 

  14. Shimko MS, Tollefson MK, Umbreit EC, Farmer SA, Blute ML, Frank I (2011) Long-term complications of conduit urinary diversion. J Urol 185(2):562–567. https://doi.org/10.1016/j.juro.2010.09.096

    Article  PubMed  Google Scholar 

  15. Minnillo BJ, Maurice MJ, Schiltz N, Pillai AC, Koroukian SM, Daneshgari F, Kim SP, Abouassaly R (2015) Few modifiable factors predict readmission following radical cystectomy. Can Urol Assoc J 9(7–8):E439–E446. https://doi.org/10.5489/cuaj.2793

    Article  PubMed  PubMed Central  Google Scholar 

  16. Aghazadeh MA, Barocas DA, Salem S, Clark PE, Cookson MS, Davis R, Gregg J, Stimson CJ, Smith JA Jr, Chang SS (2011) Determining factors for hospital discharge status after radical cystectomy in a large contemporary cohort. J Urol 185(1):85–89. https://doi.org/10.1016/j.juro.2010.08.016

    Article  PubMed  Google Scholar 

  17. Moschini M, Gandaglia G, Dell’Oglio P, Fossati N, Cucchiara V, Burgio G, Mattei A, Damiano R, Shariat SF, Salonia A, Montorsi F, Briganti A, Colombo R, Gallina A (2015) Incidence and predictors of 30-day readmission in patients treated with radical cystectomy: a single center european experience. Clin Genitour Cancer. https://doi.org/10.1016/j.clgc.2015.12.017

    Google Scholar 

  18. Stimson CJ, Chang SS, Barocas DA, Humphrey JE, Patel SG, Clark PE, Smith JA Jr, Cookson MS (2010) Early and late perioperative outcomes following radical cystectomy: 90-day readmissions, morbidity and mortality in a contemporary series. J Urol 184(4):1296–1300. https://doi.org/10.1016/j.juro.2010.06.007

    Article  CAS  PubMed  Google Scholar 

  19. Hu M, Jacobs BL, Montgomery JS, He C, Ye J, Zhang Y, Brathwaite J, Morgan TM, Hafez KS, Weizer AZ, Gilbert SM, Lee CT, Lavieri MS, Helm JE, Hollenbeck BK, Skolarus TA (2014) Sharpening the focus on causes and timing of readmission after radical cystectomy for bladder cancer. Cancer 120(9):1409–1416. https://doi.org/10.1002/cncr.28586

    Article  PubMed  Google Scholar 

  20. Schmid M, Chiang HA, Sood A, Campbell L, Chun FK, Dalela D, Okwara J, Sammon JD, Kibel AS, Menon M, Fisch M, Trinh QD (2016) Causes of hospital readmissions after urologic cancer surgery. Urol Oncol 34(5):236.e211–236.e231. https://doi.org/10.1016/j.urolonc.2015.11.019

    Article  Google Scholar 

  21. Nielsen ME, Mallin K, Weaver MA, Palis B, Stewart A, Winchester DP, Milowsky MI (2014) Association of hospital volume with conditional 90-day mortality after cystectomy: an analysis of the National Cancer Data Base. BJU Int 114(1):46–55. https://doi.org/10.1111/bju.12566

    Article  PubMed  PubMed Central  Google Scholar 

  22. Porter MP, Gore JL, Wright JL (2011) Hospital volume and 90-day mortality risk after radical cystectomy: a population-based cohort study. World J Urol 29(1):73–77. https://doi.org/10.1007/s00345-010-0626-3

    Article  PubMed  Google Scholar 

  23. Leow JJ, Reese S, Trinh QD, Bellmunt J, Chung BI, Kibel AS, Chang SL (2015) Impact of surgeon volume on the morbidity and costs of radical cystectomy in the USA: a contemporary population-based analysis. BJU Int 115(5):713–721. https://doi.org/10.1111/bju.12749

    Article  PubMed  Google Scholar 

  24. Prout GR Jr, Wesley MN, Yancik R, Ries LA, Havlik RJ, Edwards BK (2005) Age and comorbidity impact surgical therapy in older bladder carcinoma patients: a population-based study. Cancer 104(8):1638–1647. https://doi.org/10.1002/cncr.21354

    Article  PubMed  Google Scholar 

  25. Nielsen ME, Shariat SF, Karakiewicz PI, Lotan Y, Rogers CG, Amiel GE, Bastian PJ, Vazina A, Gupta A, Lerner SP, Sagalowsky AI, Schoenberg MP, Palapattu GS (2007) Advanced age is associated with poorer bladder cancer-specific survival in patients treated with radical cystectomy. Eur Urol 51(3):699–706. https://doi.org/10.1016/j.eururo.2006.11.004 (discussion 706–698)

    Article  PubMed  Google Scholar 

  26. Izquierdo L, Peri L, Leon P, Ramirez-Backhaus M, Manning T, Alcaraz A, Roupret M, Solsona E, Rubio J, Sengupta S, Chan Y, Liodakis P, Gyomber D, Bolton D, Lawrentschuk N (2015) The role of cystectomy in elderly patients—a multicentre analysis. BJU Int 116(Suppl 3):73–79. https://doi.org/10.1111/bju.13227

    Article  PubMed  Google Scholar 

  27. Comploj E, West J, Mian M, Kluth LA, Karl A, Dechet C, Shariat SF, Stief CG, Trenti E, Palermo S, Lodde M, Horninger W, Madersbacher S, Pycha A (2015) Comparison of complications from radical cystectomy between old-old versus oldest-old patients. Urol Int 94(1):25–30. https://doi.org/10.1159/000358731

    Article  PubMed  Google Scholar 

  28. Roobol MJ, Heijnsdijk EA (2011) Propensity score matching, competing risk analysis, and a competing risk nomogram: some guidance for urologists may be in place. Eur Urol 60(5):931–933. https://doi.org/10.1016/j.eururo.2011.07.039 (discussion 933–934)

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street Suite 1560, Miami, FL, 33136, USA

    Bruno Nahar, Nachiketh Soodana Prakash, Vivek Venkatramani, David Alonzo, Mahmoud Alameddine, Sanjaya Swain, Sanoj Punnen, Chad Ritch, Dipen J. Parekh & Mark L. Gonzalgo

  2. Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA

    Tulay Koru-Sengul & Aliyah Gauri

  3. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA

    Tulay Koru-Sengul, Feng Miao, Sanoj Punnen, Chad Ritch, Dipen J. Parekh & Mark L. Gonzalgo

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  1. Bruno Nahar
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Correspondence to Mark L. Gonzalgo.

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Nahar, B., Koru-Sengul, T., Miao, F. et al. Comparison of readmission and short-term mortality rates between different types of urinary diversion in patients undergoing radical cystectomy. World J Urol 36, 393–399 (2018). https://doi.org/10.1007/s00345-017-2140-3

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  • DOI: https://doi.org/10.1007/s00345-017-2140-3

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