Open Access

ARTICLE

Cystectomy for benign disease: readmission, morbidity, and complications

Scott G. Erpelding¹, Adam Dugan², Sudhir Isharwal³, Stephen Strup¹, Andrew James¹, Shubham Gupta¹

1 Department of Urology, University of Kentucky, Lexington, Kentucky, USA
2 Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
3 Department of Urology, Cleveland Clinic, Cleveland, Ohio, USA
Address correspondence to Dr. Scott G. Erpelding, Department of Urology, University of Kentucky, 800 Rose Street, MS283, Lexington, KY 40536-0298 USA

Canadian Journal of Urology 2018, 25(5), 9473-9479.

Abstract

Introduction: We sought to elucidate outcomes and risks associated with cystectomy and urinary diversion for benign urological conditions compared to malignant conditions.
Materials and methods: We identified patients who underwent cystectomy and urinary diversion for benign and malignant diseases through the American College of Surgeons National Surgery Quality Improvement Program database for the period 2007-2015. Patients were selected for inclusion based upon their current procedure terminology and International Classification of Disease, Ninth Revision codes. Primary outcome was 30-day morbidity, including return to the operating room (OR); infectious, respiratory, and/or cardiovascular complications; readmission to the hospital; and mortality. Multivariable regression analyses were performed to identify associated factors.
Results: A total of 317 patients underwent cystectomy and urinary diversion for benign disease, and 5,510 patients underwent radical cystectomy with urinary diversion for cancer. Rates of major morbidity (43.2% versus 38.6%), mortality (0.9% versus 1.9%), return to OR (5% versus 5.8%), readmission (19.7% versus 21.4%), postoperative sepsis (14.5% versus 12%), and wound complications (16.1% versus 14.2%) were similar among patients undergoing cystectomy for benign and malignant conditions. In the group with cystectomy for benign conditions, smoking (OR: 3.11) and longer operative duration (OR: 1.06) were significantly associated with increased overall morbidity. Wound complications were significantly higher in smokers (OR: 3.09) and with an ASA ≥ III (OR: 5.71).
Conclusions: Patients undergoing cystectomy and urinary diversion for benign disease are at similar risk for 30-day morbidity and mortality as patients undergoing surgery for malignant conditions. Risk factors are identified that can potentially be targeted for morbidity reduction.

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