Carolinas Medical Center, Charlotte, NC
Hamza Mustafa Beano , Jiaxian He , Caitlin Hensel , William Mills Worrilow , Kris E Gaston , Peter E Clark , Stephen Boyd Riggs
Background: Readmission following Radical Cystectomy with Urinary Diversion (RCUD) is often related to Urinary Tract Infection (UTI). We hypothesized that decreasing the duration of ureteral stenting postoperatively would decrease UTI-related complications without affecting ureteroenteric stenosis (UES) rates. Methods: We analyzed a prospectively and retrospectively collected dataset for cystectomy patients at our tertiary center. Adult patient who underwent RCUD for malignancy from January 2013-January 2018 were included. Patients with a history of abdominal/pelvic radiation and continent diversions were excluded. The patient population was divided to Late stent removal group (LSR- POD 14) and early stent removal group (ESR- POD 4). Statistical methods included t-test, chi-square test and multivariate logistic regression. Results: 177 patients were included in the final analysis after inclusion/exclusion criteria were applied. The LSR (n=75) and ESR (n=102) groups were similar in preoperative characteristics except higher intracorporeal ileal conduit formation in ESR. The LSR had higher 90-day overall readmission rates (OR=2.26, 95% CI;1.13,4.51, p-value=0.021), UTI-related readmissions (OR=3.05, 95% CI:1.32,7.04, p-value=0.010) and UAE (OR=3.02, 95%CI;1.47,6.18, p-value=0.003). Conclusions: Shorter ureteral stent duration following RCUD is associated with decreased readmissions and urinary infections complications without concurrent increase in UES. Strong consideration should be directed towards early stent removal.
Characteristics | All Patients (n=177) | ESR (n=102) | LSR (n=75) | p-value |
---|---|---|---|---|
LOS- days median(range) | 6(4-45) | 6(4-45) | 6(4-31) | 0.813 |
EBL-cc median(range) | 300(20-3700) | 300(20-3700) | 300(20-2400) | 0.668 |
Total Readmissions- n(%) | 52(29.4) | 24(23.5) | 28(37.3) | 0.066 |
Urinary Readmissions- n(%) | 32(18.1) | 12(11.8) | 20(26.7) | 0.017 |
Urinary Adverse Events- n(%) | 49(27.7) | 20(19.6) | 29(38.7) | 0.007 |
Ureteral Strictures- n(%) | 15(8.5) | 6(5.9) | 9(12) | 0.177 |
Median follow-up- months | 10.8 | 7.8 | 15.1 | <0.001 |
Median stent duration- days n(range) | 13(3-43) | 5(3-29) | 17(10-43) |
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