title: Impact of the use of bowel for urinary diversion on perioperative complications and 90-day mortality in patients aged 75 years or older.
abstract: OBJECTIVE
  A potential strategy to decrease the high complication rate of radical cystectomy (RC) in the elderly is to avoid the use of bowel for urinary diversion. The aim of this study was to address this issue in a multicentre study of patients aged ≥ 75 years.
  
  
  METHODS
  We performed a retrospective, multicentre study of a consecutive series of patients aged ≥ 75 years who underwent RC for muscle-invasive bladder cancer between 2006 and 2010. Medical, surgical and wound complications were graded according to the modified Clavien-Dindo classification.
  
  
  RESULTS
  A total of 256 patients (68% men, mean age 79.6 years) were analysed. 204 (80%) patients received a urinary diversion with use of bowel and 52 (20%) a ureterocutaneostomy (UC). Patients with UC were older (82.0 vs. 78.9 years, p < 0.001) and had a higher ASA score (2.6 vs. 2.3, p = 0.007), while the mean Charlson score was lower (4.2 vs. 5.6, p < 0.001). Patients with UC had a shorter operating time (279 vs. 311 min, p = 0.002) and a shorter period in the intensive care unit (0.9 vs. 2.2 days). The overall rate of severe complications graded as Clavien III-V was significantly lower in the UC group (11.5%) as compared to patients receiving bowel for urinary diversion (25.0%) (p = 0.003). Severe (Clavien grade III-V) medical (3.9 vs. 10.3%) and surgical (2.1 vs. 14.1%) complications were all less frequent in the UC group. Inpatient, 30- and 90-day mortality was 5.8, 7.7 and 17.3% in the UC group as compared to 3.9, 5.9 and 6.9% in the bowel cohort, respectively.
  
  
  CONCLUSIONS
  UC following RC is associated with a lower complication rate in geriatric patients. The constantly increasing cohort of geriatric, multimorbid patients requiring cystectomy might justify reconsideration of this form of diversion.
authors.affiliation: Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Berger
authors.forename: Clemens
authors.initials: C
authors.lastname: Wehrberger
authors.forename: Anton
authors.initials: A
authors.lastname: Ponholzer
authors.forename: Martina
authors.initials: M
authors.lastname: Wolfgang
authors.forename: Thomas
authors.initials: T
authors.lastname: Martini
authors.forename: Eckart
authors.initials: E
authors.lastname: Breinl
authors.forename: Michael
authors.initials: M
authors.lastname: Dunzinger
authors.forename: Johann
authors.initials: J
authors.lastname: Hofbauer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Höltl
authors.forename: Klaus
authors.initials: K
authors.lastname: Jeschke
authors.forename: Steffen F
authors.initials: SF
authors.lastname: Krause
authors.forename: Walter
authors.initials: W
authors.lastname: Kugler
authors.forename: Michael
authors.initials: M
authors.lastname: Rauchenwald
authors.forename: Walter
authors.initials: W
authors.lastname: Pauer
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Stephan
authors.initials: S
authors.lastname: Madersbacher
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D015653:Cystectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014519:Ureterostomy / Q000009:adverse effects / Q000401:mortality*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods / Q000401:mortality*