title: Urinary diversion in patients with spinal cord injury in the United States.
abstract: OBJECTIVE
  To describe the patterns in the use of bladder augmentation and urinary diversion to manage urologic sequelae among patients with spinal cord injury in the United States.
  
  
  METHODS
  Discharge estimates were derived from the Nationwide Inpatient Sample. All patients underwent bladder augmentation or ileal conduit diversion from 1998 to 2005 and had a diagnosis of spinal cord injury.
  
  
  RESULTS
  Ileal loop diversion was performed in an estimated 1919 patients and bladder augmentation in 1132 patients with spinal cord injury from 1998 to 2005. Patients undergoing urinary diversion tended to be older (mean age 46 vs 34 years; P <.001) and to have Medicare as the primary payer (55.0% vs 30.8%; P <.001). Patients who underwent urinary diversion appeared to use more healthcare resources, with a longer length of stay (15 vs 9 days), higher hospital charges ($58,626 vs $37,222), and a greater use of home healthcare services after discharge (all P <.001). Patients at teaching institutions were more likely to undergo bladder augmentation (42%) than those at nonteaching institutions (23%; P <.001).
  
  
  CONCLUSIONS
  Bladder augmentation is used in approximately one-third of cases to manage the urologic complications of spinal cord injury. These patients likely constitute a clinically distinct population that uses fewer healthcare resources. The lower augmentation rates at nonteaching institutions may indicate an opportunity for quality improvement.
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Peterson
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Shea
authors.forename: Kristy M
authors.initials: KM
authors.lastname: Borawski
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Schulman
authors.forename: Charles D
authors.initials: CD
authors.lastname: Scales
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013119:Spinal Cord Injuries / Q000150:complications*; D014481:United States; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000601:surgery*; D014547:Urinary Diversion; D013520:Urologic Surgical Procedures