Maurice MJ, Kim SP, Abouassaly R. Socioeconomic status is associated with urinary diversion utilization after radical cystectomy for bladder cancer.
Int Urol Nephrol 2016;
49:77-82. [PMID:
27696214 DOI:
10.1007/s11255-016-1422-9]
[Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/18/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE
To assess socioeconomic disparities in urinary diversion utilization in a contemporary American cohort.
METHODS
In the National Cancer Database, we identified 4538 patients who underwent cystectomy with urinary diversion for clinical T1-2N0M0 bladder cancer from 2010 to 2013. Multivariable logistic regression was used to identify predictors of urinary diversion type: ileal conduit (IC), continent cutaneous reservoir (CCR), or orthotopic neobladder (ON). Covariates included age, gender, race, income, Charlson score, clinical T stage, hospital cystectomy volume, teaching status, and surgical approach. Subgroup analysis by hospital volume (low, intermediate, or high) and teaching status (academic or non-academic) was performed to ascertain the impact of regionalization on urinary diversion use.
RESULTS
The final cohort included 4066 (89.6 %) patients with IC, 292 (6.4 %) with CCR, and 180 (4.0 %) with ON. On multivariable analysis, younger age (p < .01), higher income (p < .01), and high cystectomy volume predicted increased use of CCR and ON. Female gender predicted increased use of CCR versus IC (p < .01), and academic hospital status predicted increased use of ON versus IC (p = .04). On subgroup analysis, after further adjustment for hospital volume and teaching status, higher income remained an independent predictor of ON use.
CONCLUSIONS
Despite regionalization of care, higher income patients are more likely to receive complex urinary diversions after radical cystectomy. Other related socioeconomic factors, especially patient education, may influence this practice pattern.
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