Perioperative complications of conduit urinary diversion with concomitant cystectomy for benign indications: A population-based analysis.
Perioperative complications of conduit urinary diversion with concomitant cystectomy for benign indications: A population-based analysis.
复制标题
良性适应症导管尿流改道联合膀胱切除术的围手术期并发症：基于人群的分析。
DOI：
10.1002/nau.23135
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发表时间：
2017
影响因子：
2
通讯作者：
Reynolds,WStuart
中科院分区：
文献类型：
--
作者：
Brown,ElizabethTimbrook;Osborn,David;Mock,Stephen;Ni,Shenghua;Graves,AmyJ;Milam,Laurel;Milam,Douglas;Kaufman,MelissaR;Dmochowski,RogerR;Reynolds,WStuart
目的除了单机构病例系列外，有限的数据可用于描述在良性终末期下尿路功能障碍的尿流改道时进行并发膀胱切除术的风险。使用人口代表性的样本，本研究旨在分析与围手术期并发症的患者接受尿流改道或不cyadministration.MethodsA的良性适应症的患者进行尿流改道的相关因素，确定从医疗保健成本和利用项目全国范围内的住院患者样本从1998年至2011年的代表性样本。采用国际疾病分类第9版对尿流改道伴或不伴膀胱炎的围手术期并发症进行识别和编码。多变量logistic回归模型确定了与并发症相关的医院和患者水平的特征伴随膀胱尿流改道.ResultsThere是15，717记录确定的尿流改道，其中31. 8%的围手术期并发症：尿流改道并发膀胱尿流改道（35. 0%）和尿流改道无并发膀胱尿流改道（30. 6%）。比较两组，尿流改道时伴随的膀胱炎与并发症显著相关（OR = 1.23，95%CI：1.03 - 1.48）。肥胖、肺循环疾病、药物滥用、体重减轻和电解质紊乱的共病状况与并发症呈正相关，而私人保险和南部地理区域则呈负相关。ConclusionsA伴随的尿流改道治疗难治性下尿路功能障碍会增加这一人群代表性样本的风险，尤其是那些有某些共病状况的患者。该分析为术前患者咨询提供了重要信息。
AimsBeyond single‐institution case series, limited data are available to describe risks of performing a concurrent cystectomy at the time of urinary diversion for benign end‐stage lower urinary tract dysfunction. Using a population‐representative sample, this study aimed to analyze factors associated with perioperative complications in patients undergoing urinary diversion with or without cystectomy.MethodsA representative sample of patients undergoing urinary diversion for benign indications was identified from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1998 to 2011. Perioperative complications of urinary diversion with and without concomitant cystectomy were identified and coded using the International Classification of Diseases, version 9. Multivariate logistic regression models identified hospital and patient‐level characteristics associated with complications of concomitant cystectomy with urinary diversion.ResultsThere were 15,717 records for urinary diversion identified, of which 31.8% demonstrated perioperative complications: urinary diversion with concurrent cystectomy (35.0%) and urinary diversion without concomitant cystectomy (30.6%). Comparing the two groups, a concomitant cystectomy at the time of urinary diversion was significantly associated with a complication (OR = 1.23, 95%CI: 1.03‐1.48). Comorbid conditions of obesity, pulmonary circulation disease, drug abuse, weight loss, and electrolyte disorders were positively associated with a complication, while private insurance and southern geographic region were negatively associated.ConclusionsA concomitant cystectomy with urinary diversion for refractory lower urinary tract dysfunction elevates risk in this population‐representative sample, particularly in those with certain comorbid conditions. This analysis provides critical information for preoperative patient counseling.