Introduction

Radical cystectomy (RC) is a complex and morbid procedure primarily because of the urinary diversion required after bladder removal. Choosing the optimal diversion type can be challenging and depends on clinical parameters, as well as the potential morbidity related to each approach. We analyzed a large national oncology outcomes database and compared 30 day readmission rates, as well as 30 and 90 day mortality rates between different types of urinary diversion among patients undergoing RC.

Methods

We identified patients who underwent RC for bladder cancer in the National Cancer Data Base (NCDB) from 2004 to 2013. Patients were grouped based on the type of urinary diversion performed: non-continent (ileal conduit [IC]) or two continent techniques (pouch [CP] or orthotopic neobladder [NB]). We used multivariable logistic regression models to compare 30 day unplanned readmission and 30 and 90 day mortality between the different types of urinary diversion. In order to control for residual confounding we performed a propensity score matching and repeated the analysis.

Results

Among 11,933 patients who underwent RC, we identified 10,197 (85.5%) IC, 1,044 (8.7%) CP, and 692 (5.8%) NB. Patients who received IC were significantly older and had more comorbidities (p<.0001). Continent diversions were more likely to be performed at an academic center (p<.0001). In multivariate analysis, patients undergoing NB had an increased likelihood of being readmitted (OR 1.41, p=.010), but decreased risk of dying within 90 days (OR 0.47, p=.007). However, after propensity score matching there was no significant difference in short-term mortality within groups. Surgery performed at a non-academic center was an independent predictor of readmission within 30 days of discharge (OR: 1.19, p=.010) and death within 30 days of surgery (OR 1.27, p=.043).

Conclusions

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

Funding

none