To identify non-clinical factors affecting post-operative complication rates in patients with neurogenic bladder undergoing benign genitourinary (GU) reconstruction.
Adult patients with neurogenic bladder undergoing benign GU reconstruction between 10/2010 and 11/2015 were included. Patients were excluded if a diversion was performed for malignancy, if patients had a history of radiation or if a new bowel segment was not utilized at the time of the operation. Clinical and non-clinical factors were abstracted from the patients' electronic medical records. Health literacy was assessed via the Brief Health Literacy Screen (BHLS), a validated 3-question assessment. Education, marital status and distance from the medical center were also queried.
Forty-nine patients with a neurogenic bladder undergoing complex GU reconstruction met inclusion and exclusion criteria. On average, patients lived 111 (SD 89) miles from the hospital. Overall mean BHLS score was 10.4 (SD 4.6) with 35% of patients scoring a BHLS of less than or equal to 9. Mean years of educational attainment was 9.7, and only 31% of patients completed high school education. In the first month after surgery, 37 (76%) patients experienced a complication, and 22% were readmitted, however analysis of complication data did not identify an association between any non-clinical variables and complication rates.
Non-clinical factors including unmarried status, poor health literacy and marked distance from quaternary care are prevalent in patients with neurogenic bladder undergoing complex GU reconstruction. To mitigate these potential risk factors the authors recommend acknowledgment of these factors and multi-disciplinary support peri-operatively to counteract them.
Urology. 2018 Oct 23 [Epub ahead of print]
Rachel Sosland, Casey A Kowalik, Josh A Cohn, Doug F Milam, Melissa R Kaufman, Roger R Dmochowski, W Stuart Reynolds
Vanderbilt University Medical Center, A-1302 Medical Center North, Vanderbilt University Medical Center, Nashville, TN 37232-2765. Electronic address: ., Vanderbilt University Medical Center, A-1302 Medical Center North, Vanderbilt University Medical Center, Nashville, TN 37232-2765.