Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
BJU Int. 2018 Dec;122(6):1016-1024. doi: 10.1111/bju.14448. Epub 2018 Jul 26.
To investigate the impact of continent urinary diversion on readmissions and hospital costs in a nationally representative sample of radical cystectomies (RCs) performed in the USA.
The 2010-2014 Nationwide Readmissions Database was queried for patients with a diagnosis of bladder cancer who underwent RC. We identified patients undergoing continent (neobladder or continent cutaneous reservoir) or incontinent (ileal conduit) diversions. Multivariable logistic regression models were used to identify predictors of 90-day readmission, prolonged length of stay, and total hospital costs.
Amongst 21 126 patients identified, 19 437 (92.0%) underwent incontinent diversion and 1 689 (8.0%) had a continent diversion created. Continent diversion patients were younger, healthier, and treated at high-volume metropolitan centres. Continent diversions resulted in fewer in-hospital complications (37.3% vs 42.5%, P = 0.02) but led to more 90-day readmissions (46.5% vs 39.6%, P = 0.004). In addition, continent diversion patients were more often readmitted for infectious complications (38.7% vs 29.4%, P = 0.004) and genitourinary complications (18.5% vs 13.0%, P = 0.01). On multivariable logistic regression, patients with a continent diversion were more likely to be readmitted within 90 days (odds ratio [OR] 1.55, 95% confidence interval [CI]: 1.28, 1.88) and have increased hospital costs during initial hospitalisation (OR 1.99, 95% CI: 1.52, 2.61). Continent diversion led to a $4 617 (American dollars) increase in initial hospital costs ($36 640 vs $32 023, P < 0.001), which was maintained at 30 days ($48 621 vs $44 231, P < 0.001) and at 90 days ($56 380 vs $52 820, P < 0.001).
In a nationally representative sample of RCs performed in the USA, continent urinary diversion led to more frequent readmissions and increased hospital costs. Interventions designed to address specific outpatient issues with continent diversions can potentially lead to a significant decrease in readmissions and associated hospital costs.
在全美范围内接受根治性膀胱切除术（RC）的患者样本中，研究尿流改道对 90 天再入院和医院费用的影响。
在 2010-2014 年全国再入院数据库中，对诊断为膀胱癌且接受 RC 的患者进行了查询。我们确定了接受有控（新膀胱或有控皮储）或无控（回肠导管）分流的患者。使用多变量逻辑回归模型确定 90 天再入院、延长住院时间和总住院费用的预测因素。
在确定的 21126 例患者中，19437 例（92.0%）接受了无控分流，1689 例（8.0%）接受了有控分流。有控分流患者年龄较小、健康状况较好，且在高容量大都市中心接受治疗。有控分流导致更少的院内并发症（37.3%比 42.5%，P=0.02），但导致更多的 90 天再入院（46.5%比 39.6%，P=0.004）。此外，有控分流患者更常因感染并发症（38.7%比 29.4%，P=0.004）和泌尿生殖系统并发症（18.5%比 13.0%，P=0.01）而再次入院。在多变量逻辑回归中，接受有控分流的患者在 90 天内再次入院的可能性更高（比值比[OR]1.55，95%置信区间[CI]：1.28，1.88），且初次住院期间的医院费用增加（OR 1.99，95%CI：1.52，2.61）。有控分流导致初始住院费用增加 4617 美元（美元）（36640 美元比 32023 美元，P<0.001），这一数字在 30 天（48621 美元比 44231 美元，P<0.001）和 90 天（56380 美元比 52820 美元，P<0.001）时保持不变。
在全美范围内接受 RC 的患者样本中，有控尿流改道导致再入院率更高，且增加了医院费用。旨在解决有控分流患者门诊特定问题的干预措施可能会显著降低再入院率和相关的医院费用。
