■在输尿管-回肠吻合术中放置输尿管支架以进行带回肠导管的根治性膀胱切除术(RCIC)长期以来一直是普遍的做法。最近,一些提供者已经开始省略支架。我们试图调查在输尿管回肠吻合术中使用和不使用支架的根治性膀胱切除术和回肠导管(RCIC)的患者之间围手术期和30天预后的差异。
■我们在国家外科质量改善计划数据库和相应的膀胱切除术目标参与者使用文件中确定了2019年至2021年之间进行的RCIC。基线人口统计,合并症,通过Pearson卡方检验和t检验比较了支架和无支架RCIC的手术参数。感兴趣的结果,包括尿路感染(UTI)的发生率,急性肾损伤(AKI),肾衰竭需要透析,回肠吻合口瘘,输尿管梗阻,尿漏或瘘形成,重新操作,使用Pearson卡方比较30天的再入院率。所有统计检验均为2尾,P<.05被认为是显著的。
■确定了五千四百十八个RCIC。四百九十八(9.2%)无支架。基线人口统计学或合并症没有差异。接受机器人辅助手术的支架患者明显减少(23%vs29%,P<.01)。支架患者的尿漏或瘘形成率较低(3.1%vs4.8%,P=.04)。30天的UTI发生率没有显着差异,AKIs,肾功能衰竭,回肠吻合口瘘,输尿管梗阻,重新操作,和再入院。局限性包括回顾性设计和过去30天缺乏纵向跟踪。
■在最重要的30天结局中,无支架患者的结局与支架患者的结局不差。我们的分析表明,在回肠导管尿流改道手术中可能不需要支架。
UNASSIGNED: Placing ureteral
stents at the uretero-ileal anastomosis for radical cystectomy with ileal conduit (RCIC) has long been common practice. Recently, some providers have begun omitting
stents. We sought to investigate differences in perioperative and 30-day outcomes between patients who underwent radical cystectomy with ileal conduit (RCIC) with and without
stents placed at the uretero-ileal anastomosis.
UNASSIGNED: We identified RCICs performed between 2019 to 2021 in the National Surgical Quality Improvement Program database and corresponding Cystectomy-Targeted Participant Use File. Baseline demographics, comorbidities, and operative parameters were compared via Pearson\'s chi-square and t-tests between stented and stent-less RCICs. Outcomes of interest, including rates of urinary tract infections (UTIs), acute kidney injury (AKI), renal failure requiring dialysis, ileoileal anastomotic leaks, ureteral obstruction, urinary leak or fistula formation, reoperations, and 30-day hospital readmissions were compared using Pearson\'s chi-square. All statistical tests were 2 tailed with P < .05 considered significant.
UNASSIGNED: Five Thousand Four Hundred Eighteen RCICs were identified. Four hundred ninety-eight (9.2%) were stent-less. There were no differences in baseline demographics or comorbidities. Significantly fewer stented patients had robotic-assisted operations (23% vs 29%, P < .01). Stented patients had lower rates of urinary leak or fistula formation (3.1% vs 4.8%, P = .04). There was no significant difference in 30-day rates of UTIs, AKIs, renal failure, ileoileal anastomotic leaks, ureteral obstruction, reoperations, and readmissions. Limitations include retrospective design and lack of longitudinal tracking past 30 days.
UNASSIGNED: Stent-less patients had non-inferior outcomes compared to stented patients in most important 30-day outcomes. Our analysis suggests that
stents may not be necessary in ileal conduit urinary diversion procedures.