Variability in Health Care Utilization and Perioperative Outcomes Among Urinary Diversion Patients: Analysis of the National Surgical Quality Improvement Program Database.

INTRODUCTION

Bladder cancer (BC) urinary diversion (UD) outcomes remain the benchmark to which all other UDs are compared. However, a sizable proportion are performed for other invasive cancers or benign etiologies of the bladder. We aim to compare health care utilization (HU) and 30-day morbidity among benign and malignant UD etiologies.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program was used to collect data on 20,885 patients who underwent UD for various indications: BC, gastrointestinal/gynecologic cancer (GC), radiation (R), interstitial cystitis/benign bladder, and neurogenic bladder/bowel (NGB; assigned using International Classification of Diseases codes). Risk-adjusted regression models were developed to identify predictors of HU, prolonged length of stay (PLOS), 30-day readmissions, discharge to continued care (DCC), and morbidity (30-day complications and mortality). Frailty was also compared among different etiologies using the 5-Item Frailty Index.

RESULTS

Most patients had primary BC (91%, N = 19,060). GC had the highest complication rate (71%) and PLOS (50%), R had the highest readmission rate (23%), while NGB had the highest DCC (30%). GC was the least frail (≈14% with 5-Item Frailty Index ≥2) while NGB and R were the frailest (28% and 27%, respectively, P < .05). Moreover, frail radiated patients had the highest HU rate (81%, P < .001) while frail patients with GC had the highest complication rate (77%, P < .001). Compared with patients with BC, adjusted odds of PLOS, DCC, and 30-day complication rates significantly differed among UD etiologies (P < .05), except for interstitial cystitis/benign bladder.

CONCLUSIONS

Postoperative HU and morbidity are greatly influenced by UD etiology. Care management in these vulnerable patient populations requires an individualized etiology-centered approach and cannot be benchmarked against those undergoing BC UD.