Iatrogenic Bladder Injury: National Analysis of 30-Day Outcomes

Andrew J Cohen; Vignesh T Packiam; Charles U Nottingham; Joseph J Pariser; Sarah F Faris; Gregory T Bales

doi:10.1016/j.urology.2016.05.002

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Iatrogenic Bladder Injury: National Analysis of 30-Day Outcomes

Journal article

Peer reviewed

Iatrogenic Bladder Injury: National Analysis of 30-Day Outcomes

Andrew J Cohen, Vignesh T Packiam, Charles U Nottingham, Joseph J Pariser, Sarah F Faris and Gregory T Bales

Urology (Ridgewood, N.J.), Vol.97, pp.250-256

11/2016

DOI: 10.1016/j.urology.2016.05.002

PMID: 27181242

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Abstract

To examine the risk factors and outcomes of BI, a rare complication of abdominopelvic surgery. We queried the National Surgical Quality Improvement Program database to identify intraoperative bladder injury (BI) defined by the Current Procedural Terminology code for cystorrhaphy from 2005 to 2013. Propensity-score matching balanced the differences between patients with BI and the controls. The factors matched included age, body mass index, race, modified frailty index, and procedure category. There were 1685 cases of BI in 1,541,736 surgeries (0.11%). Although 49.5% of surgeries were performed in an open fashion, this approach accounted for 69.3% of BI (P < .001). Prior to matching, mortality rates and morbidity were increased for the BI group (P < .001). Moreover, age, recent chemotherapy or radiation or steroid history, and smoking were among the risk factors for BI (all P < .05). Resident involvement increased the odds of BI and complications after BI, but decreased the risk of readmission (all P < .05). After matching, 30-day mortality was no longer increased for patients with BI (P < .001). Patients with BI requiring repair did have increased median length of stay (6 days [interquartile range {IQR}: 3-11] vs 5 [IQR: 2-9]; P < .001) and operative time (203 min [IQR: 140-278] vs 134 [IQR: 86-199]; P < .001). BI patients were more likely to undergo reoperation (7.7% vs 5.3%; P = .005). Urine infection, sepsis, and bleeding were more likely in the BI group compared with the matched controls (all P < .001). Delayed repair was rare. We present the largest national series assessing iatrogenic BI and subsequent repair. BI increases 30-day complications, reoperation, and length of stay but does not increase 30-day mortality compared with matched controls. More complex surgical cases and increased baseline comorbidity were risk factors for BI.

Abdomen - surgery

Age Factors

Antineoplastic Agents - therapeutic use

Clinical Competence

Hemorrhage - epidemiology

Hemorrhage - etiology

Humans

Iatrogenic Disease - epidemiology

Internship and Residency

Intraoperative Complications - epidemiology

Intraoperative Complications - surgery

Length of Stay - statistics & numerical data

Mortality

Operative Time

Patient Readmission - statistics & numerical data

Pelvis - surgery

Postoperative Complications - epidemiology

Radiotherapy

Reoperation - statistics & numerical data

Risk Factors

Sepsis - epidemiology

Sepsis - etiology

Smoking - epidemiology

Steroids - therapeutic use

Surgical Wound - complications

Surgical Wound - epidemiology

Surgical Wound - surgery

United States - epidemiology

Urinary Bladder - injuries

Urinary Tract Infections - epidemiology

Urinary Tract Infections - etiology

Details

Title: Subtitle: Iatrogenic Bladder Injury: National Analysis of 30-Day Outcomes
Creators: Andrew J Cohen - University of Chicago
Vignesh T Packiam - University of Chicago
Charles U Nottingham - University of Chicago
Joseph J Pariser - University of Chicago
Sarah F Faris - University of Chicago
Gregory T Bales - University of Chicago
Resource Type: Journal article
Publication Details: Urology (Ridgewood, N.J.), Vol.97, pp.250-256
DOI: 10.1016/j.urology.2016.05.002
PMID: 27181242
ISSN: 0090-4295
eISSN: 1527-9995
Language: English
Date published: 11/2016
Academic Unit: Urology
Record Identifier: 9984320066102771

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