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A comparative propensity score‐matched analysis of perioperative outcomes of intracorporeal vs extracorporeal urinary diversion after robot‐assisted radical cystectomy: results from the International Robotic Cystectomy Consortium
Author(s) -
Hussein Ahmed A.,
Elsayed Ahmed S.,
Aldhaam Naif A.,
Jing Zhe,
Peabody James O.,
Wijburg Carl J.,
Wagner Andrew,
Canda Abdullah Erdem,
Khan Mohammad Shamim,
Scherr Douglas,
Schanne Francis,
Maatman Thomas J.,
Kim Eric,
Mottrie Alexandre,
Aboumohamed Ahmed,
Gaboardi Franco,
Pini Giovannalberto,
Kaouk Jihad,
Yuh Bertram,
Rha KoonHo,
Hemal Ashok,
Palou Redorta Joan,
Badani Ketan,
Saar Matthias,
Stockle Michael,
Richstone Lee,
Roupret Morgan,
Balbay Derya,
Dasgupta Prokar,
Me Mani,
Guru Khurshid A.
Publication year - 2020
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.15083
Subject(s) - medicine , cystectomy , propensity score matching , urinary diversion , extracorporeal , perioperative , bladder cancer , surgery , cancer
Objective To compare the perioperative outcomes of intracorporeal (ICUD) vs extracorporeal urinary diversion (ECUD) after robot‐assisted radical cystectomy (RARC).Patients and Methods We retrospectively reviewed the prospectively maintained International Robotic Cystectomy Consortium (IRCC) database. A total of 972 patients from 28 institutions who underwent RARC were included. Propensity score matching was used to match patients based on age, gender, body mass index (BMI), American Society of Anesthesiologists Score (ASA) score, Charlson Comorbidity Index (CCI) score, prior radiation and abdominal surgery, receipt of neoadjuvant chemotherapy, and clinical staging. Matched cohorts were compared. Multivariate stepwise logistic and linear regression models were fit to evaluate variables associated with receiving ICUD, operating time, 90‐day high‐grade complications (Clavien–Dindo Classification Grade ≥III), and 90‐day readmissions after RARC. Results Utilisation of ICUD increased from 0% in 2005 to 95% in 2018. The ICUD patients had more overall complications (66% vs 58%, P = 0.01) and readmissions (27% vs 17%, P = 0.01), but not high‐grade complications (21% vs 24%, P = 0.22). A more recent RC era and ileal conduit diversion were associated with receiving an ICUD. Higher BMI, ASA score ≥3, and receiving a neobladder were associated with longer operating times. Shorter operating time was associated with male gender, older age, ICUD, and centres with a larger annual average RC volume. Longer intensive care unit stay was associated with 90‐day high‐grade complications. Higher CCI score, prior radiation therapy, neoadjuvant chemotherapy, and ICUD were associated with a higher risk of 90‐day readmissions. Conclusions Utilisation of ICUD has increased over the past decade. ICUD was associated with more overall complications and readmissions compared to ECUD, but not high‐grade complications.