Mp65-10 variability in health care utilization and perioperative outcomes among urinary diversion patients

You have accessJournal of UrologyCME1 Apr 2023MP65-10 VARIABILITY IN HEALTH CARE UTILIZATION AND PERIOPERATIVE OUTCOMES AMONG URINARY DIVERSION PATIENTS Anthony Fadel, Bridget L. Findlay, Katherine T. Anderson, Vidit Sharma, and Boyd R. Viers Anthony FadelAnthony Fadel More articles by this author , Bridget L. FindlayBridget L. Findlay More articles by this author , Katherine T. AndersonKatherine T. Anderson More articles by this author , Vidit SharmaVidit Sharma More articles by this author , and Boyd R. ViersBoyd R. Viers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder cancer urinary diversion (UD) outcomes remain the benchmark to which all other UD are compared. However, a sizable proportion are done for other invasive cancers or benign etiologies of the bladder. There is a paucity of literature comparing outcomes of UD for various indications, both benign and malignant. Herein, we aim to compare health care utilization and 30-day morbidity among benign and malignant UD etiologies. METHODS: Data were collected from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2005-2020 on adult patients who underwent UD for various indications. ICD codes were used to assign patients to the following categories: Bladder Cancer (BC), GI/GYN Cancer (GC), Radiation (R), Fistula (F), Interstitial Cystitis/Benign Bladder (IB), and Neurogenic Bladder/Bowel (NGB). Patients that did not fall into these categories were excluded. Baseline characteristics and The Five Item Frailty Index (FFI) were compared across the 6 groups. Univariate and multivariate risk-adjusted regression models were developed to identify predictors of morbidity (30-day complications and mortality) and healthcare utilization (HU): prolonged length of stay (PLOS), 30-day readmissions (AR), and discharge to continued care (DCC). RESULTS: A total of 22,534 patients met inclusion criteria. The majority had primary bladder cancer (88%), were males (79%), with a median age of 69. GC had the highest complication rate (64%) and PLOS (44%), R had the highest readmission rate (24%), while NGB had the highest DCC (29%). GC and IB were the least frail (≈ 14% with FFI≥2) while NGB were the frailest (29%, p<.05). After adjusting for baseline characteristics (BC reference), there was a significant difference in PLOS, DCC, AR, and 30-day complication rates among different etiologies (p<.05, Figure 1). There was no significant difference in 30-day mortality. Compared to those with BC, those with NGB, F, R, and GC had significantly greater risk of serious complications and HU, whereas those with IB had a lower risk (p<.05). 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. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e894 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony Fadel More articles by this author Bridget L. Findlay More articles by this author Katherine T. Anderson More articles by this author Vidit Sharma More articles by this author Boyd R. Viers More articles by this author Expand All Advertisement PDF downloadLoading ...