Urinary Diversion Versus Adverse In-Hospital Outcomes After Radical Cystectomy

This study aimed to compare adverse in-hospital outcomes in ileal conduit versus neobladder urinary diversion type after radical cystectomy (RC) in contemporary versus historical patients.

Patients were identified within the National Inpatient Sample (NIS 2000–2019). Propensity score matching (PSM; 1:2 ratio) and multivariable logistic regression models (LRMs) were used.

Of 10,533 contemporary (2011–2019) patients, 943 (9.0%) underwent neobladder urinary diversion, while 9590 (91.0%) underwent ileal conduit urinary diversion. Furthermore, of 9742 historical (2010–2019) patients, 932 (9.6%) underwent neobladder urinary diversion and 8810 (90.4%) underwent ileal conduit urinary diversion. After 1:2 PSM, within the contemporary cohort, 943/943 (100%) neobladder versus 1886/9590 (19.6%) ileal conduit patients were included. Similarly, within the historical cohort, 932/932 (100%) neobladder versus 1864/8810 (21.1%) ileal conduit patients were included after PSM. In multivariable LRMs, relative to contemporary neobladder patients, contemporary ileal conduit patients exhibited higher rates of overall postoperative (49.0 vs. 43.6%; multivariable odds ratio [MOR] 1.2), wound (4.2 vs. 2.7%; MOR 1.6), and genitourinary (13.1% vs. 10.0%; MOR 1.3) complications as well as blood transfusions (19.0 vs. 15.6%; MOR 1.3). Conversely, in multivariable LRMs within the historical cohort, no differences were recorded between ileal conduit and neobladder patients.

Unlike historical comparisons between ileal conduit and neobladder patients, where no differences in adverse in-hospital outcomes were recorded, analyses relying on a contemporary patient cohort subject to PSM and multivariable adjustment revealed higher rates of adverse in-hospital outcomes in 4/13 examined categories. This observation should be considered at informed consent.