A comparative analysis of complication rates in urinary diversions: Exploring the impact of contemporary surgical trends.

Abstract

751 Background: Historically, outcomes have been similar among patients undergoing continent (CD) and incontinent diversion (ID) at time of radical cystectomy (RC), with no difference in complication rates. Given the decreasing rates of CD, we sought to examine postoperative complication rates based on type of diversion in a contemporary cohort. Methods: Data was extracted from the NSQIP database from 2019-2021 who underwent RC. Patients were stratified based on diversion type. Statistical endpoints included thirty-day complications, length of stay (LOS), and readmissions. Optimal RC outcome was defined as absence of any postoperative complication, reoperation, prolonged LOS (75th percentile, 8 days) with no readmission. Multivariable analyses with Bonferroni correction were performed to assess the association between urinary diversion and postoperative outcomes. Results: A total of 4375 patients were identified, including 3780 (86.4%) who underwent ID and 595 (13.6%) who underwent CD. Compared to patients with CD, those with ID were more likely to be older, female, have higher ASA, worse renal function, robotic/lap approach, history of radiation or pelvic surgery, and higher stage (Table). On multivariable analysis, after Bonferroni adjustment, patients with CD had increased odds of high grade complications (OR 1.58; 99% CI [1.15-2.15]) and readmission (OR 1.7 [1.28-2.27]) as well as lower odds of an optimal outcome (OR 0.74 [0.58-0.95]) compared to incontinent diversion. Conclusions: In a contemporary cohort of patients undergoing RC, odds of adverse postoperative outcomes were increased among those undergoing CD compared to ID, despite more favorable baseline characteristics in this cohort. Preoperative and operative characteristics for patients undergoing radical cystectomy procedures stratified by diversion type. Incontinent Continent P-value Characteristic N=3780 N=595  Age 72.0 [65.0;77.0] 63.0 [57.0;69.0] <0.001  Sex: 0.001 Female 734 (19.4%) 80 (13.4%) Male 3046 (80.6%) 515 (86.6%) Year of Surgery: 0.33  2019 1450 (38.4%) 240 (40.3%)  2020 1601 (42.4%) 255 (42.9%)  2021 729 (19.3%) 100 (16.8%) ASA: <0.001  <3 752 (19.9%) 185 (31.1%)  ≥3 3028 (80.1%) 410 (68.9%) eGFR 68.3 [51.8;87.3] 77.3 [62.7;92.8] <0.001 BMI 27.8 [24.7;31.6] 27.5 [24.9;31.1] 0.704 Chemotherapy 1320 (34.9%) 276 (46.4%) <0.001 Radiation 346 (9.15%) 22 (3.70%) <0.001 Prior Pelvic Surgery 1863 (49.3%) 258 (43.4%) 0.008 Surgical Approach: <0.001  Open 2672 (70.7%) 467 (78.5%)  Hybrid 185 (4.89%) 20 (3.36%)  Lap/Robo 923 (24.4%) 108 (18.2%) OR Time 312 [240;393] 369 [280;465] <0.001 # Nodes 16.0 [10.0;25.0] 17.0 [11.0;26.5] 0.001 AJCC Stage: <0.001  0a-II 1833 (48.5%) 370 (62.2%)  III-IV 1947 (51.5%) 225 (37.8%) ASA: American Society of Anesthesiologist classification. BMI: body mass index. OR: operating room. AJCC: American Joint Committee on Cancer. # of nodes: median, [IQR].