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Extended case duration and hypotension are associated with higher-grade postoperative complications after urinary diversion for non-oncological disease

Urology Sep 21, 2017

Santiago-Lastra Y, et al. - This trial strived to report the patients' survival for those who underwent urinary diversion for benign indications. Furthermore, it determined the risk factors for morbidity at 90 days. A good 5-year survival was reported for urinary Diversion of non-oncological conditions. A link was brought to light between extended case duration and hemodynamic instability during or immediately after urinary diversion with a high-grade complication within 90 days of the procedure.

Methods

  • The consecutive urinary diversions with or without cystectomy for non-oncological indications were weighed at a single institution.
  • The indication for diversion was intractable incontinence, upper tract deterioration, urinary fistula, and unmanageable bladder pain.
  • Enrollees were categorized on the basis of their most severe complication within 90 days of surgery, through the Clavien-Dindo system.
  • Multivariable analysis determined the factors related to high-grade complications.
  • Survival analysis was carried out.

Results

  • 141 patients were reported to have undergone urinary diversion for non-oncological indications, between 2007-2014.
  • The postoperative rate of high-grade adverse events (class III or greater) was 28%.
  • Risk factors for class III or greater complications at 90 days comprised of prolonged intra-operative mean arterial pressure below 75% of baseline, operative duration greater than 343 minutes, and postoperative vasopressor requirement.
  • A 1- and 5-year survival of 88.4% and 77.2% was illustrated via Kaplan-Meier survival analysis.
  • There was no statistical variation in the long-term survival of patients who experienced higher-grade complications from the survival of the rest of the group.
  • Limitation was noted in terms of retrospective design and sample size in determining additional variables related to increased risk of long-term mortality.

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