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Dissecting the role of radical cystectomy and urinary diversion in post-operative complications: an analysis using the American College of Surgeons national surgical quality improvement program database
Anaissie, James; Dursun, Furkan; Wallis, Christopher J D; Klaassen, Zachary; Taylor, Jennifer; Obando-Perez, Cinthya; Xu, Jiaqiong; Boone, Timothy; Khavari, Rose; Satkunasivam, Raj.
  • Anaissie, James; Baylor College of Medicine. Michael E. DeBakey Veterans Affairs Medical Center. Department of Urology. Houston. US
  • Dursun, Furkan; Houston Methodist Hospital. Department of Urology. Houston. US
  • Wallis, Christopher J D; Vanderbilt University. Department of Urology. Nashville. US
  • Klaassen, Zachary; Augusta University. Medical College of Georgia. Division of Urology. Augusta. US
  • Taylor, Jennifer; Baylor College of Medicine. Michael E. DeBakey Veterans Affairs Medical Center. Department of Urology. Houston. US
  • Obando-Perez, Cinthya; Houston Methodist Hospital. Department of Urology. Houston. US
  • Xu, Jiaqiong; Houston Methodist Hospital. Center for Outcomes Research. Houston. US
  • Boone, Timothy; Houston Methodist Hospital. Department of Urology. Houston. US
  • Khavari, Rose; Houston Methodist Hospital. Department of Urology. Houston. US
  • Satkunasivam, Raj; Houston Methodist Hospital. Department of Urology. Houston. US
Int. braz. j. urol ; 47(5): 1006-1019, Sept.-Oct. 2021. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1286808
ABSTRACT
ABSTRACT

Objective:

To characterize the contribution of the extirpative and reconstructive portions of radical cystectomy (RC) to complications rates, and assess differences between urinary diversion (UD) types. Materials and

Methods:

We conducted a retrospective cohort study comparing patients undergoing UD alone or RC+UD for bladder cancer from 2006 to 2017 using ACS National Surgical Quality Improvement Program database. The primary outcome was major complications, while secondary outcomes included minor complications and prolonged length of stay. Propensity score matching (PSM) was utilized to assess the association between surgical procedure (UD alone or RC+UD) and outcomes, stratified by diversion type. Lastly, we examined differences in complication rates between ileal conduit (IC) vs. continent UD (CUD).

Results:

When comparing RC + IC and IC alone, PSM yielded 424 pairs. IC alone had a lower risk of any complication (HR 0.63, 95% CI 0.52-0.75), venous thromboembolism (HR 0.45, 95% CI 0.22-0.91) and bleeding needing transfusion (HR 0.41, 95% CI 0.32-0.52). This trend was also noted when comparing RC + CUD to CUD alone. CUD had higher risk of complications than IC, both with (56.6% vs 52.3%, p = 0.031) and without RC (47.8% vs 35.1%, p=0.062), and a higher risk of infectious complications, both with (30.5% vs 22.7%, p<0.001) and without RC (34.0% vs 22.0%, p=0.032).

Conclusions:

RC+UD, as compared to UD alone, is associated with an increased risk of major complications, including bleeding needing transfusion and venous thromboembolism. Additionally, CUD had a higher risk of post-operative complication than IC.
Asunto(s)


Texto completo: Disponible Índice: LILACS (Américas) Asunto principal: Derivación Urinaria / Neoplasias de la Vejiga Urinaria / Cirujanos Tipo de estudio: Estudio observacional / Factores de riesgo Límite: Humanos País/Región como asunto: America del Norte Idioma: Inglés Revista: Int. braz. j. urol Asunto de la revista: Urología Año: 2021 Tipo del documento: Artículo País de afiliación: Estados Unidos Institución/País de afiliación: Augusta University/US / Baylor College of Medicine/US / Houston Methodist Hospital/US / Vanderbilt University/US

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Texto completo: Disponible Índice: LILACS (Américas) Asunto principal: Derivación Urinaria / Neoplasias de la Vejiga Urinaria / Cirujanos Tipo de estudio: Estudio observacional / Factores de riesgo Límite: Humanos País/Región como asunto: America del Norte Idioma: Inglés Revista: Int. braz. j. urol Asunto de la revista: Urología Año: 2021 Tipo del documento: Artículo País de afiliación: Estados Unidos Institución/País de afiliación: Augusta University/US / Baylor College of Medicine/US / Houston Methodist Hospital/US / Vanderbilt University/US