br Metropolitan br Urban br Rural br Insurance status br
Miles from patient’s residence to hospital
*Surgical approach grouped by single year.
Sample [11−13] and the National Surgical Quality Improvement Program . We report trends not only on the overall CD rate, but also on the population receiving CD and how the CD rate among those variables has changed, which has not been previously explored.
Furthermore, prior studies on RCs did not report the relationship between surgical approach and method of UD.
This study provides novel insight into the role that open and MIS approaches play in resulting ID and CD. With the increasing adoption of robotic RC, its influence on choice of UD should be taken into consideration.
There are several limitations to acknowledge in this study including an inherent risk of bias with a retrospective observational study. While the NCDB provides information
Trends in continent diversion rates
Year of diagnosis
Charlson comorbidity index
Health and age status
% of no high school graduates in patient’s zip code of residence
Miles from patient’s residence to hospital
on hospital volume, data regarding individual surgeon vol-ume are not available and the impact of surgeon volume on UD rates cannot be assessed. Previously, higher surgeon volume was shown to be associated with increased use of CD in a study Erlotinib that spanned from 2002 to 2010 .
Contraindications to CD such as renal or liver disease and ability to catheterize are not captured by the NCDB. The decision for choice of UD represents an ideal situation for shared decision making. The lack of information on patient preference needs to be considered when attempting to
explain trends in the use of CD. The NCDB does not distin-guish intracorporeal vs. extracorporeal diversion after MIS surgery. Due to the technically challenging nature of per-forming robotic intracorporeal continent diversion, patients may be limited in their diversion choice to IC. Further stud-ies are needed to evaluate how diversions are managed after robotic surgery as experience of the surgeon improves.
The rate of continent diversion after RC for bladder cancer in the United States has downtrended from 17.2% in 2004 to 2006 to 12.1% in 2010 to 2013. Higher income, facility geo-graphic location in the West, academic program, high hospital volume, and traveling >60 miles for care were positively associated with receiving CD. Despite an overall national decline in CD, high-volume hospitals performing a larger pro-portion of open RCs had higher rates of CD compared to high-volume MIS facilities. There are multiple patient, facil-ity, and surgical level variables associated with CD utilization of which MIS as a surgical approach appears to impact choice of diversion, indicating the potential need for increased focus on patient counseling regarding diversion options.
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