Introduction:

Continent diversions (CD) during radical cystectomy (RC) are associated with improved quality of life; however, are considered contraindicated in patients with poor renal function due to increased urine dwell time and solute absorption causing metabolic abnormalities. Our aim was to assess 30-day complications based on eGFR and urinary diversion (UD) type.

Methods:

The National Surgical Quality Improvement Program database was queried for RC and UD with curative intent for bladder cancer from 2006-2018. Exclusions included dialysis patients and unrelated concomitant procedures. Patients were divided into four categories: eGFR>60 with incontinent diversion (ID) (5,785 patients), eGFR>60 with CD (1,618 patients), eGFR<60 with ID (2,883 patients), and eGFR<60 with CD (350 patients). Preoperative eGFR was calculated with the CKD-EPI 2021 equation. Complications were categorized as infectious (urinary tract infection/sepsis/septic shock), thromboembolic (deep venous thrombosis/pulmonary embolism), renal (progressive/acute renal failure), wound (superficial/deep/organ-space surgical site infections and dehiscence), pulmonary (pneumonia/reintubation/prolonged ventilatory support), and cardiac (myocardial infarction and cardiac arrest).

Results:

10,636 patients underwent RC with UD (8,668 IC and 1,968 CD). On multivariable logistic regression, patients with eGFR<60 had higher mortality odds that was highest in those who received CD compared to ID (OR 2.716 vs.1.453, respectively). Patients with CD had higher rates of thromboembolic and infectious complications and risk was higher with eGFR<60. Renal complications were increased in all groups and highest in eGFR<60 with CD (Table).

Conclusion:

30-day complication rates differ based on diversion type and eGFR. Pre-operative renal function is an important consideration when counseling patients upon type of UD.

Funding: Grant from the National Cancer Institute (P30CA072720).