title: Perioperative complications of conduit urinary diversion with concomitant cystectomy for benign indications: A population-based analysis.
abstract: OBJECTIVE
  Beyond single-institution case series, limited data are available to describe risks of performing a concurrent cystectomy at the time of urinary diversion for benign end-stage lower urinary tract dysfunction. Using a population-representative sample, this study aimed to analyze factors associated with perioperative complications in patients undergoing urinary diversion with or without cystectomy.
  
  
  METHODS
  A representative sample of patients undergoing urinary diversion for benign indications was identified from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1998 to 2011. Perioperative complications of urinary diversion with and without concomitant cystectomy were identified and coded using the International Classification of Diseases, version 9. Multivariate logistic regression models identified hospital and patient-level characteristics associated with complications of concomitant cystectomy with urinary diversion.
  
  
  RESULTS
  There were 15,717 records for urinary diversion identified, of which 31.8% demonstrated perioperative complications: urinary diversion with concurrent cystectomy (35.0%) and urinary diversion without concomitant cystectomy (30.6%). Comparing the two groups, a concomitant cystectomy at the time of urinary diversion was significantly associated with a complication (OR = 1.23, 95%CI: 1.03-1.48). Comorbid conditions of obesity, pulmonary circulation disease, drug abuse, weight loss, and electrolyte disorders were positively associated with a complication, while private insurance and southern geographic region were negatively associated.
  
  
  CONCLUSIONS
  A concomitant cystectomy with urinary diversion for refractory lower urinary tract dysfunction elevates risk in this population-representative sample, particularly in those with certain comorbid conditions. This analysis provides critical information for preoperative patient counseling.
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Elizabeth Timbrook
authors.initials: ET
authors.lastname: Brown
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: David
authors.initials: D
authors.lastname: Osborn
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mock
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Shenghua
authors.initials: S
authors.lastname: Ni
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Graves
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Laurel
authors.initials: L
authors.lastname: Milam
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Douglas
authors.initials: D
authors.lastname: Milam
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Kaufman
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: W Stuart
authors.initials: WS
authors.lastname: Reynolds
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D014547:Urinary Diversion / Q000009:adverse effects*; D055815:Young Adult
keywords: comorbidities; complications; cystectomy; neurogenic bladder; urinary diversion