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

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

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.

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.

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.

World journal of urology. 2017 Dec 11 [Epub ahead of print]

Bruno Nahar, Tulay Koru-Sengul, Feng Miao, Nachiketh Soodana Prakash, Vivek Venkatramani, Aliyah Gauri, David Alonzo, Mahmoud Alameddine, Sanjaya Swain, Sanoj Punnen, Chad Ritch, Dipen J Parekh, Mark L Gonzalgo

Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street Suite 1560, Miami, FL, 33136, USA., Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA., Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA., Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street Suite 1560, Miami, FL, 33136, USA. .