title: Ureteral stenting in laparoscopic colorectal surgery.
abstract: BACKGROUND
  Few studies have examined the current status of ureteral stent use or the indications for stenting, particularly in laparoscopic colorectal surgery. This study examines current national trends and predictors of ureteral stenting in patients undergoing major colorectal operations and the subsequent effects on perioperative outcomes.
  
  
  METHODS
  The 2005-2011 National Surgical Quality Improvement participant user files were used to identify patients undergoing laparoscopic segmental colectomy, low anterior resection, or proctectomy. Trends in stent use were assessed across procedure types. To estimate the predictors of stent utilization, a forward-stepwise logistic regression model was used. A 3:1 nearest neighbor propensity match with subsequent multivariable adjustment was then used to estimate the impact of stents.
  
  
  RESULTS
  A total of 42,311 cases were identified, of which 1795 (4.2%) underwent ureteral stent placement. Predictors of stent utilization included diverticular disease, need for radical resection (versus segmental colectomy), recent radiotherapy, and more recent calendar year. After adjustment, ureteral stenting appeared to be associated with a small increase in median operative time (44 min) and a trivial increase in length of stay (5.4%, P<0.001). However, there were no significant differences in morbidity or mortality.
  
  
  CONCLUSIONS
  We describe the clinical predictors of ureteral stent usage in this patient population and report that while stenting adds to operative time, it is not associated with significantly increased morbidity or mortality after adjusting for diagnosis and comorbidities. Focused institutional studies are necessary in the future to address the utility of ureteral stents in the identification and possible prevention of iatrogenic injury.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina; Division of Urology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Zachariah G
authors.initials: ZG
authors.lastname: Goldsmith
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nussbaum
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Turley
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina; Division of Urology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Peterson
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina; Section of Colon and Rectal Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: christopher.mantyh@duke.edu.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
mesh_terms: D003082:Colectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D015607:Stents; D014513:Ureter
keywords: Colorectal resection; Iatrogenic injury; Injury identification; Laparoscopic surgery; Propensity analysis; Ureteral injury; Ureteral stenting; Urinary tract injury