title: Frequency of lower urinary tract injury after gastrointestinal surgery in the nationwide inpatient sample database.
abstract: Bladder and ureteral injury are serious iatrogenic complications during abdominal and pelvic surgery but are poorly investigated in the general surgery literature. The objective of this study was to examine rates, trends, and patient and surgical characteristics present in lower urinary tract injuries during gastrointestinal surgery using the Nationwide Inpatient Sample (NIS) database. The NIS database was queried from 2002 to 2010 for gastrointestinal surgery procedures including small/large bowel, rectal surgery, and procedures involving a combination of the two. These were crossreferenced with bladder and ureteral injury using International Classification of Diseases, 9th Revision, Clinical Modification codes. Multivariate regression analysis was used to calculate odds ratios for hypothesized risk factors. From 2002 to 2010, total average rates of bladder injury and ureteral injury were 0.15 and 0.06 per cent, respectively. Small/large bowel procedures had lower annual rates of ureteral (0.05 to 0.07%) and bladder (0.12 to 0.14%) injuries compared with ureteral (0.11 to 0.25%) and bladder (0.27 to 0.41%) injuries in rectal procedures. Presence of metastatic disease was associated with the greatest risk for bladder (odds ratio, 2.0; 95% confidence interval, 1.8 to 2.2) and ureteral (2.2; 1.9 to 2.5) injury in small/large bowel surgery, and for bladder (3.1; 2.5 to 3.9) and ureteral (4.0; 3.2 to 5.0) injury in combination procedures. Injury rates were significantly greater in open surgeries compared with laparoscopic procedures for both bladder injury (0.78 vs 0.26%, P < 0.0001) and ureteral injury (0.34 vs 0.06%, P < 0.0001). The incidence of genitourinary (GU) injury in gastrointestinal surgery is rare, less than 1.0 per cent, and is less than the incidence of GU injury reported in gynecologic surgery. This risk is increased by operations on the rectum and the presence of malignancy.
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Hari P
authors.initials: HP
authors.lastname: Sawkar
authors.forename: Dae Y
authors.initials: DY
authors.lastname: Kim
authors.forename: D Joseph
authors.initials: DJ
authors.lastname: Thum
authors.forename: Lee
authors.initials: L
authors.lastname: Zhao
authors.forename: John
authors.initials: J
authors.lastname: Cashy
authors.forename: Marc
authors.initials: M
authors.lastname: Bjurlin
authors.forename: Vishal
authors.initials: V
authors.lastname: Bhalani
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Boller
authors.forename: Shilajit
authors.initials: S
authors.lastname: Kundu
mesh_terms: D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D007431:Intraoperative Complications / Q000145:classification* / Q000453:epidemiology* / Q000503:physiopathology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012044:Regression Analysis; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014513:Ureter / Q000293:injuries* / Q000601:surgery; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery