POPULATION BASED ASSESSMENT OF CONTINENT DIVERSION UTILIZATION AND PERIOPERATIVE MORBIDITY IN THE UNITED STATES
The choice between continent and incontinent forms of urinary diversion is an important decision for bladder cancer patients undergoing radical cystectomy which involves numerous patient- and disease-specific factors. Our objective was to describe patient demographics, facility-related factors, temporal trends, and perioperative morbidity and mortality by comparing ileal conduits (IC) to continent diversion (CD).
We queried the National Cancer Database (NCDB) to identify patients with primary bladder cancer who underwent radical cystectomy plus IC or CD ("abdominal pouch", orthotopic pouch, or unspecified continent reservoir) from 2004 to 2013. The NCDB only specifies type of diversion in males, therefore females were excluded. Logistic regression was used to assess impact of diversion on length of stay (LOS), readmission, and 30-day mortality between types of UD.
Overall, 19,646 (82.8%) patients had an IC while 3,522 (15.2%) patients had a CD after their RC. Patients who underwent CD were younger, had fewer comorbidities, graduated high school, had private insurance, earned higher income, lived in a metropolitan county, and traveled >60 miles to the hospital (Table) (p<0.01). CD was more likely to be performed at academic/research programs and high volume hospitals (Table) (p<0.01). The rate of continent diversion has decreased from 18.3% in 2004 to 12.2% in 2013 (p<0.01). On multivariable logistic regression controlling for age, comorbidity, and stage of disease, patients with CD when compared to IC were more likely to experience longer LOS (OR 1.16, p=<0.01). Readmission (p=0.41) and 30-day mortality (p=0.28) were not statistically different between the diversion groups. </p>
Patients who underwent CD were younger, healthier, of higher socioeconomic status, more likely to travel for care, and be treated at an academic institution compared to patients undergoing IC. After adjusting for age, comorbidities, and disease characteristics, CD was associated with a higher risk of longer hospital stay, but there was no difference in readmission rates or 30-day mortality. From 2004 to 2013, the rate of continent diversion declined in the United States.