Abstract: PD38-06
Sources of Funding: none

Introduction

We expand our knowledge on the risks of cystectomy and urinary diversion for benign disease by analyzing 30-day morbidity, readmission, mortality, and predictors of adverse outcomes in a multi-center, prospectively maintained, outcomes based clinical cohort.

Methods

This is an analysis of data obtained from academic and community medical centers during the years of 2007 to 2015 through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The study population consists of patients who underwent cystectomy with urinary diversion for benign disease. Patients were identified based upon their primary CPT code as well as documented ICD-9 codes. The primary outcome was a composite 30-day morbidity measure which includes mortality, readmission, return to the operating room, sepsis, transfusion, wound compilations, deep vein thrombosis, pulmonary embolism, renal failure and prolonged mechanical ventilation.

Results

We identified 405 patients who underwent cystectomy for benign disease. 246 (60.7%) patients experienced morbidity within 30 days following surgery. Overall mortality was 1.5%. 20.8% were readmitted within 30 days after surgery. Furthermore, 31.1% required transfusion, 14.3 % had sepsis or septic shock and 4.4% required a return to the operating room. Bivariate analysis demonstrated that operative time was a significant predictor of major morbidity (p 0.0009), as well as post-operative length of stay (p 0.0051). Other predictors of morbidity included smoking (p 0.0113), and hematocrit <30 (p 0.0210). Predictors for post-operative length of stay included functional dependence (p 0.0091), albumin <3 (p 0.0184), and pre-op weight loss >10% (p 0.0307).

Conclusions

Patients undergoing cystectomy and urinary diversion for benign disease experienced post-operative morbidity at a high rate with over 60% of patients encountering some form of complication. Smoking, anemia, and longer operative times were associated with increased morbidity. Poor nutrition, poor functional status, weight loss and longer operative times were associated with longer length of stay after surgery. These results illuminate potential modifiable risk factors for improving outcomes and decreasing cost.

Funding

none