Erpelding Scott G, Dugan Adam, Isharwal Sudhir, Strup Stephen, James Andrew, Gupta Shubham
Department of Urology, University of Kentucky, Lexington, Kentucky, USA.
Can J Urol. 2018 Oct;25(5):9473-9479.
We sought to elucidate outcomes and risks associated with cystectomy and urinary diversion for benign urological conditions compared to malignant conditions.
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.
A total of 317 patients underwent cystectomy and urinary diversion for benign disease, and 5510 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.
我们试图阐明与良性泌尿系统疾病相比，恶性疾病行膀胱切除术和尿流改道的结局和风险。
我们通过美国外科医师学会国家外科质量改进计划数据库，确定了2007年至2015年期间因良性和恶性疾病接受膀胱切除术和尿流改道的患者。根据患者当前的手术操作术语和国际疾病分类第九版编码选择纳入患者。主要结局是30天发病率，包括返回手术室（OR）；感染、呼吸和/或心血管并发症；再次入院；以及死亡率。进行多变量回归分析以确定相关因素。
共有317例患者因良性疾病接受膀胱切除术和尿流改道，5510例患者因癌症接受根治性膀胱切除术并尿流改道。良性和恶性疾病行膀胱切除术的患者在主要发病率（43.2%对38.6%）、死亡率（0.9%对1.9%）、返回手术室（5%对5.8%）、再次入院（19.7%对21.4%）、术后脓毒症（14.5%对12%）和伤口并发症（16.1%对14.2%）方面相似。在良性疾病行膀胱切除术的组中，吸烟（OR：3.11）和手术时间较长（OR：1.06）与总体发病率增加显著相关。吸烟者（OR：3.09）和ASA≥III级（OR：5.71）患者的伤口并发症明显更高。结论：因良性疾病接受膀胱切除术和尿流改道的患者与因恶性疾病接受手术的患者在30天发病率和死亡率方面风险相似。已确定可潜在针对降低发病率的危险因素。
