Cystectomy with urinary diversion for benign disease: indications and outcomes.
OBJECTIVE
To analyze what factors contribute to a worse outcome after cystectomy and urinary diversion for benign disease as measured by the frequency of severe complications.


METHODS
A retrospective review was performed of consecutive patients who underwent a cystectomy for benign disease. The primary outcome was the type and severity of complications, according to Clavien-Dindo scale.


RESULTS
A total of 139 patients underwent cystectomy with diversion for benign diseases over the study period. The most common indications for surgery were spinal cord injury (32%) and radiation damage to the bladder (18%). The average preoperative age-adjusted Charlson comorbidity index was 4.6. Seventy-four patients (53%) underwent supratrigonal cystectomy. Mean surgery duration was 344±103 minutes, and the mean estimated blood loss was 476±379 mL. The most common complications were perioperative blood transfusion, prolonged ileus, and pyelonephritis. Seventy-nine patients (57%) had a complication grade≥II on the Clavien-Dindo scale. This did not differ based on indication for surgery, age, gender, body mass index, age-adjusted Charlson comorbidity index, estimated blood loss, or type of cystectomy. After adjustment, only duration of surgery in 10-minute increments (odds ratio, 1.07; 95% confidence interval, 1.02-1.12; P=.007) was associated with an increased incidence of serious complication.


CONCLUSIONS
Most of the patients experience some complication after cystectomy and urinary diversion for benign indications. Duration of surgery is an important variable that can affect outcome.
Department of Urology, Vanderbilt University Medical Center, Nashville, TN. Electronic address: david.osborn@vanderbilt.edu.
David James
DJ
Osborn
Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
Roger R
RR
Dmochowski
Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
Melissa R
MR
Kaufman
Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
Douglas F
DF
Milam
Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
Stephen
S
Mock
Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
W Stuart
WS
Reynolds
D000328:Adult; D017677:Age Distribution; D000368:Aged; D016063:Blood Loss, Surgical / Q000503:physiopathology; D015331:Cohort Studies; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D017678:Sex Distribution; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000473:pathology* / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*