The changing landscape of urinary diversion post cystectomy: A 15-year analysis of the NSQIP database.

BACKGROUND

Radical cystectomy (RC) with urinary diversion is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer. While continent urinary diversions offer potential quality-of-life benefits, their adoption over time remains poorly defined.

OBJECTIVE

To evaluate national trends in the use of continent versus incontinent urinary diversion following RC and identify demographic and clinical factors associated with diversion type.

METHODS

We analyzed data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2008 to 2022. Patients undergoing RC with urinary diversion were identified using CPT codes. Diversion type, temporal trends, and associated demographic and clinical variables were assessed using descriptive statistics and multivariable Firth logistic regression models.

RESULTS

Among 26,587 patients, 85.1% received incontinent diversion and 14.9% received continent diversion. The use of continent diversion declined significantly over time, particularly among males, patients under 75 years old, and White patients. No significant trends were observed among female, Black or Asian patients.

CONCLUSION

Continent urinary diversions have declined over the past decade despite surgical advancements, with notable variation by age, sex, and race. These findings highlight the influence of clinical and sociodemographic factors on diversion selection. The extent to which these findings reflect practice patterns beyond NSQIP remains uncertain.