title: Short-term morbidity and mortality of Indiana pouch, ileal conduit, and neobladder urinary diversion following radical cystectomy.
abstract: OBJECTIVE
  Literature surrounding Indiana pouch (IP) urinary diversion suggests a higher incidence of complications and longer operative time compared with ileal conduit (IC) and neobladder (NB). We sought to assess short-term complications of IP diversions compared with other diversions at our institution.
  
  
  METHODS
  Using institutional National Surgical Quality Improvement Program data, we identified radical cystectomy cases performed for bladder cancer at Indiana University from January 2011 until June 2013. During this time period, the National Surgical Quality Improvement Program randomly evaluated approximately 70% of radical cystectomies performed for urothelial carcinoma at our institution. Multivariable logistic regression was performed to identify factors associated with Clavien grade III-V complications.
  
  
  RESULTS
  A total of 233 cases were identified, 139 IC, 39 IP, and 55 NB. Mean (standard deviation) operative times for IC, IP, and NB were 257 (84), 383 (78), and 327 (88) minutes, respectively (P<0.001). Half of the patients required blood transfusion during the hospitalization. The overall rate of complications was significantly lower among NB (P = 0.009). Overall, 12% of patients developed a Clavien grade III-V complication, with no difference observed between groups (P = 0.884). After controlling for preoperative confounders, IP patients were not at increased odds of developing a Clavien III-V complication compared with IC (odds ratio = 1.38, P = 0.599).
  
  
  CONCLUSIONS
  At a high-volume center, the incidence of serious complications was similar between diversion types. IP patients were more likely to experience minor complications. Patients should be counseled regarding rates of short-term complications and blood transfusion.
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN. Electronic address: mmonn@iupui.edu.
authors.forename: M Francesca
authors.initials: MF
authors.lastname: Monn
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Hristos Z
authors.initials: HZ
authors.lastname: Kaimakliotis
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: K Clint
authors.initials: KC
authors.lastname: Cary
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Pedrosa
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Chandra K
authors.initials: CK
authors.lastname: Flack
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Koch
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Richard
authors.initials: R
authors.lastname: Bihrle
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D060787:Neoplasm Grading; D011788:Quality of Life; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000401:mortality*
keywords: Bladder cancer; NSQIP; Radical cystectomy; Urinary diversion