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  • br Metropolitan br Urban br Rural br Insurance status br

    2020-08-12


    Metropolitan
    Urban
    Rural
    Insurance status
    Not insured
    Private/managed care
    Medicaid
    Medicare
    Other
    Miles from patient’s residence to hospital
    MIS
    Open
    *Surgical approach grouped by single year.
    Sample [11−13] and the National Surgical Quality Improvement Program [14]. 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
    P
    Age
    Charlson comorbidity index
    Health and age status
    Race
    % of no high school graduates in patient’s zip code of residence
    Median income
    Facility type
    Facility location
    Hospital volume
    County description
    Insurance status
    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 [23]. 
    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.
    5. Conclusion
    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.
    References
    [3] Shariat Erlotinib SF, Karakiewicz PI, Palapattu GS, et al. Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contem-porary series from the Bladder Cancer Research Consortium. J Urol 2006;176:2414.
    [4] Nieuwenhuijzen JA, de Vries RR, Bex A, et al. Urinary diversions after cystectomy: the association of clinical factors, complications and functional results of four different diversions. Eur Urol 2008;53:834.
    [5] Gburek BM, Lieber MM, Blute ML. Comparison of studer ileal neo-bladder and ileal conduit urinary diversion with respect to periopera-tive outcome and late complications. J Urol 1998;160:721.
    [6] Singh V, Yadav R, Sinha RJ, et al. Prospective comparison of quality-of-life outcomes between ileal conduit urinary diversion and 
    orthotopic neobladder reconstruction after radical cystectomy: a sta-tistical model. BJU Int 2014;113:726.
    [7] Hara I, Miyake H, Hara S, et al. Health-related quality of life after radical cystectomy for bladder cancer: a comparison of ileal conduit and orthotopic bladder replacement. BJU Int 2002;89:10.
    [8] Daneshmand S, Bartsch G. Improving selection of appropriate urinary diversion following radical cystectomy for bladder cancer. Expert Rev Anticancer Ther 2011;11:941.
    [11] Kim SP, Shah ND, Weight CJ, et al. Population-based trends in uri-nary diversion among patients undergoing radical cystectomy for bladder cancer. BJU Int 2013;112:478.
    [12] Gore JL, Litwin MS, Project UDiA. Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy. World J Urol 2009;27:45.