Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.
BJU Int. 2013 Aug;112(4):478-84. doi: 10.1111/j.1464-410X.2012.11508.x. Epub 2013 Mar 1.
What's known on the subject? and what does the study add?: Variations in the type of urinary diversion exist for patients undergoing radical cystectomy. Although its use has been increasing from 2001 to 2008, patients who are older, female, and primary insured by Medicaid are less likely to receive continent diversions. Furthermore, patients treated surgically at high-volume and teaching hospitals are more likely to receive continent diversions.
To describe the contemporary trends in urinary diversion among patients undergoing radical cystectomy (RC) for bladder cancer; and elucidate whether socioeconomic disparities persist in the type of diversion performed in the USA from a population-based cohort.
Using the Nationwide Inpatient Sample, we identified patients who underwent RC for bladder cancer between 2001 and 2008. Multivariable regression models were used to identify patient and hospital covariates associated with continent urinary diversion and enumerate predicted probabilities for statistically significant variables over time.
Overall, 55635 (92%) patients undergoing RC for bladder cancer received incontinent urinary diversion, while 4552 (8%) patients received continent diversion from 2001 to 2008. Receipt of continent urinary diversion increased from 6.6% in 2001-2002 to 9.4% in 2007-2008 (P < 0.001 for trend). Patients who were older (odds ratio [OR] 0.93; P < 0.001), female (OR 0.52; P < 0.001) and insured by Medicaid (OR 0.54; P = 0.002) were less likely to receive continent urinary diversion. However, patients treated at teaching (OR 2.14; P < 0.001) and high-volume hospitals (OR 2.39; P = 0.04) had higher odds of continent urinary diversion. Predicted probabilities of continent diversion remained lower for female patients, Medicaid insurance status, and non-teaching and medium/low-volume hospitals over time.
In this nationally representative sample of hospitals from 2001 to 2008, the use of continent diversion in RC gradually increased. Although variations in urinary diversion exist by hospital teaching status, case volume, patient gender and primary health insurance, increased attention in expanding the use of continent diversions may help reduce these disparities for patients undergoing RC for bladder cancer.
目的：描述美国人群中接受根治性膀胱切除术（RC）治疗膀胱癌患者的当代尿路转流趋势；并阐明在接受手术治疗的医院类型、患者性别和医疗保险类型方面是否存在持续的社会经济差异。
方法：使用全国住院患者样本，我们确定了 2001 年至 2008 年间接受 RC 治疗膀胱癌的患者。多变量回归模型用于确定与continent 性尿流改道相关的患者和医院协变量，并随着时间的推移枚举有统计学意义的变量的预测概率。
结果：总体而言，55635（92%）名接受 RC 治疗膀胱癌的患者接受了非continent 性尿流改道，而 4552（8%）名患者接受了 continent 性尿流改道。从 2001-2002 年的 6.6%到 2007-2008 年的 9.4%（趋势 P<0.001），接受 continent 性尿流改道的比例有所增加。年龄较大（优势比[OR]0.93；P<0.001）、女性（OR 0.52；P<0.001）和 Medicaid 保险（OR 0.54；P=0.002）的患者不太可能接受 continent 性尿流改道。然而，在教学（OR 2.14；P<0.001）和高容量医院（OR 2.39；P=0.04）接受治疗的患者 continent 性尿流改道的几率更高。随着时间的推移，女性患者、 Medicaid 保险状态以及非教学和中等/低容量医院的 continent 性尿流改道预测概率仍然较低。
结论：在 2001 年至 2008 年的全国代表性医院样本中，RC 中 continent 性尿流改道的使用逐渐增加。尽管在医院教学地位、病例量、患者性别和主要医疗保险方面存在尿路转流差异，但更多关注 continent 性尿流改道的使用可能有助于减少接受 RC 治疗膀胱癌的患者之间的这些差异。
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