title: Temporal Trends in Conduit Urinary Diversion With Concomitant Cystectomy for Benign Indications: A Population-based Analysis.
abstract: OBJECTIVE
  To describe national trends in cystectomy at the time of urinary diversion for benign indications. Multiple practice patterns exist regarding the necessity for concomitant cystectomy with urinary diversion for benign end-stage lower urinary tract dysfunction. Beyond single-institution reports, limited data are available to describe how concurrent cystectomy is employed on a national level.
  
  
  METHODS
  A representative sample of patients undergoing urinary diversion for benign indications with or without concurrent cystectomy was identified from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1998 to 2011. Using multivariate logistic regression models, we identified hospital- and patient-level characteristics associated with concomitant cystectomy with urinary diversion.
  
  
  RESULTS
  There was an increase in the proportion of concomitant cystectomy at the time of urinary diversion from 20% to 35% (P < .001) between 1998 and 2011. The increase in simultaneous cystectomy over time occurred at teaching hospitals (vs community hospitals), in older patients, in male patients, in the Medicare population (vs private insurance and Medicaid), and in those with certain diagnoses.
  
  
  CONCLUSIONS
  There has been an overall increase in the use of cystectomy at the time of urinary diversion for benign indications on a national level, although the indications driving this clinical decision appear inconsistent.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: elizabeth.t.brown@vanderbilt.edu.
authors.forename: Elizabeth Timbrook
authors.initials: ET
authors.lastname: Brown
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: David
authors.initials: D
authors.lastname: Osborn
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mock
authors.affiliation: The Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Shenghua
authors.initials: S
authors.lastname: Ni
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Graves
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Laurel
authors.initials: L
authors.lastname: Milam
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Douglas
authors.initials: D
authors.lastname: Milam
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Kaufman
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: W Stuart
authors.initials: WS
authors.lastname: Reynolds
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making / Q000379:methods*; D015653:Cystectomy / Q000379:methods / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D014481:United States; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods / Q000639:trends*; D055815:Young Adult