Perioperative Predictors of Length of Stay and Readmission After Simple Cystectomy and Urinary Diversion in Nonambulatory Adults With Neurogenic Bladder.

OBJECTIVE

To identify factors associated with readmission and length of stay (LOS) after simple cystectomy in neurogenic patients to inform Enhanced Recovery After Surgery (ERAS) pathway development. ERAS protocols improve outcomes after oncologic cystectomy, but guidance for neurogenic populations is limited.

METHODS

This retrospective study identified patients with Multiple Sclerosis (MS), Spinal Cord Injury (SCI), Spina Bifida (SB), or related conditions who underwent cystectomy (2013 and 2023). Exclusion criteria were age ≤18, cystectomy without diversion, and ambulatory patients. Primary outcomes were LOS and readmission. Secondary outcomes were ileus and wound complications. Associations were analyzed using Wilcoxon, Fisher's exact, Spearman, and Kruskal-Wallis tests.

RESULTS

Eighty-five patients were included (55% male; median age 52; 43 SCI, 20 MS, 16 SB, and 6 others). Median LOS was 7 days. Thirty-day readmission occurred at 24%. Longer LOS was associated with older age (ρ = 0.23, P = .033), lower preoperative hemoglobin (ρ = -0.26, P = .016), and greater blood loss (ρ = 0.25, P = .023). Postoperative ileus (P < .001), total parenteral nutrition use (P < .001) and wound complications (P < .001) were associated with prolonged hospitalization. Longer operative time predicted readmission (540 vs 435 minutes, P = .04). Discharge home showed a nonsignificant trend toward higher readmission than facility discharge (29% vs 12%, P = .10).

CONCLUSION

Longer hospitalization was associated with older age, lower hemoglobin, greater blood loss, and postoperative complications. Longer operative time predicted readmission. These findings identify modifiable targets for ERAS pathways tailored to neurogenic patients.