Gender Disparity in Cystectomy Postoperative Outcomes: Propensity Score Analysis of the National Surgical Quality Improvement Program Database

Bukavina, Laura; Mishra, Kirtishri; Mahran, Amr; Shekar, Anjali; Sheyn, David; Slopnick, Emily; Hijaz, Adoniz; Jankowski, Jason T.; Ponsky, Lee; Nguyen, Carvell T.

doi:10.1016/j.euo.2019.04.004

Cited by 20 publications

(15 citation statements)

References 30 publications

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“…As one of the first symptoms of bladder cancer, hematuria may be misinterpreted in females as part of a urinary tract infection, thus resulting in a prolonged time between symptoms and diagnosis (22,23). Aside from that, differences in hormonal and genetic factors, tumor biology, smoking habits, and occupational risk factors as well as postoperative complication rates have been investigated (8,12,24). Moreover, women were more likely to present with squamous cell carcinoma, which was associated with a worse oncologic outcome (20,25,26).…”

Section: Gender Differences In Oncological Outcomesmentioning

confidence: 99%

“…The main concern of organ-preserving RC is its oncological safety. Several studies demonstrated the technical feasibility of ROPRC without compromising oncological outcomes compared to standard RC (24,29). However, due to a lack of high-quality data, there is no recommendation for ROPRC as a standard alternative to standard RC for women (2,29).…”

Section: Oncological Safety Of Roprcmentioning

confidence: 99%

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Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Deimling¹,

Laukhtina²,

Pradère³

et al. 2022

Transl Androl Urol

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Background and Objective: Standard radical cystectomy (RC) in women includes the removal of the bladder, urethra, uterus with the adnexa, and the anterior vaginal wall, thereby severely affecting the urinary, sexual, and reproductive system. To limit these detrimental effects, organ-sparing, including nerve-sparing approaches, have been developed. Health-related quality of life (HRQOL) and functional outcomes are, indeed, becoming increasingly central to the shared decision-making with the patient. The objectives of this narrative review are: (I) to review the current status of RC in women, including the use of different urinary diversions (UDs); (II) to discuss organ-sparing approaches and their impact on oncological and functional outcomes in women; (III) to discuss the impact of RC on HRQOL and sexual function in women.Methods: We performed a non-systematic literature review of the available publications in the PubMed database.

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Section: Gender Differences In Oncological Outcomesmentioning

confidence: 99%

Section: Oncological Safety Of Roprcmentioning

confidence: 99%

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Deimling¹,

Laukhtina²,

Pradère³

et al. 2022

Transl Androl Urol

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“…Though the prevalence of bladder cancer is three to four times lower in females, which is reflected in the number of cystectomies for males and females in the NIS data, female patients appear to have worse survival when matched with male patients of the same stage, particularly with advanced stage disease [17,18]. Previous studies show that women tend to have greater delays in referral to a urologist and to RC, present more often with advanced disease, and have worse survival outcomes [18][19][20]. Postoperative outcomes for females after ORC have a similarly poor trend, with greater complications including longer operative times, surgical site infections, blood transfusion requirements, longer length of stay, and higher readmission rate [16,20].…”

Section: Commentmentioning

confidence: 99%

“…Previous studies show that women tend to have greater delays in referral to a urologist and to RC, present more often with advanced disease, and have worse survival outcomes [18][19][20]. Postoperative outcomes for females after ORC have a similarly poor trend, with greater complications including longer operative times, surgical site infections, blood transfusion requirements, longer length of stay, and higher readmission rate [16,20]. It is plausible that advanced disease and higher postoperative complication rates correlate to the nearly $2,000 higher cost of hospitalization for female patients undergoing RC.…”

Section: Commentmentioning

confidence: 99%

Cost of Care in Open Cystectomy Patients Across Time and Space: Does it matter?

et al. 2021

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BACKGROUND: Many variables may affect the cost of open radical cystectomy (RC) care, including surgical approach, diversion type, patient comorbidities, and postoperative complications. OBJECTIVE: To determine factors associated with changes in cost of care following open radical cystectomy (ORC) for bladder cancer using the National Inpatient Sample (NIS). METHODS: Patients in the NIS with a diagnosis of bladder cancer who underwent ORC with ileal conduit from 2012–2017 using ICD-9-CM and ICD-10-CM codes were identified. Baseline demographics including age, race, region, postoperative complications, and length of stay were obtained. Univariable and multivariable logistic regression were used to identify factors associated with cost variation including demographics, clinical characteristics, surgical factors, and discharge quarter (Q1-Q4). RESULTS: 5,189 patients were included in the analysis, with 4,379 at urban teaching hospitals. On multivariable regression analysis, female sex [$1,734 ($1,024–2,444) p < 0.001)], a greater Elixhauser comorbidity score [$93 ($62–124), p < 0.001], presence of any inpatient complication [$1,531 ($894–2,168), p < 0.001], and greater length of stay [$1,665 ($1,536–1,793), p < 0.001] were associated with a greater cost of hospitalization. Discharge in Q3 (July to September) relative to Q2 (April to June) was associated with a higher cost [$1,113 ($292–1,933), p = 0.008. Trends were similar at urban non-teaching and rural hospitals, except discharge quarter was not associated with a significant change in cost. CONCLUSIONS: Significant differences in cost of ORC with ileal conduit exist with respect to patient sex, medical comorbidities, and discharge timing. These differences may relate to greater disease burden in female patients, patient complexity, and variation in postoperative care in academic programs.

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“…We conclude that there is no role for prophylactic oophorectomy at the time of RC for the prevention of future ovarian cancer. In addition, given the lack of occult ovarian metastasis/involvement at the time of RC, as well as established harms of BSO, a careful risk-benefit discussion should be had with patients [10,19 ▪▪ ].…”

Section: Ovarian Preservation and Sexual Functionmentioning

confidence: 99%

Radical cystectomy and women's sexual health – can we do better?

Escott

Avulova

Bree

et al. 2022

Current Opinion in Urology

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Purpose of reviewFemale sexual function after radical cystectomy is a crucial, but historically overlooked component of bladder cancer survivorship. This review focuses on recent studies, which have investigated pelvic health and sexual function after radical cystectomy. We discuss modifiable factors, which may contribute to decreased sexual function after radical cystectomy and techniques, which may lead to improved outcomes.Recent findingsSexual function is important to women and there is a significant desire (and unmet need) for more perioperative counseling and discussion regarding sexual function changes and quality of life impacts. Sexual function may be altered due to a combination of hormonal changes from ovarian removal, anatomic changes from vaginal alteration, and sensation changes due to damage to the neurovascular bundle. Techniques to preserve these structures have been developed.SummarySexual function is an important component of survivorship and increasing attention is being focused on this area. Long term studies with objective measures are needed for to compare various techniques and ensure oncologic safety. Ovarian preservation, anterior vaginal wall preservation, and vaginal estrogen replacement should be carefully considered for most patients.

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Gender Disparity in Cystectomy Postoperative Outcomes: Propensity Score Analysis of the National Surgical Quality Improvement Program Database

Cited by 20 publications

References 30 publications

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Cost of Care in Open Cystectomy Patients Across Time and Space: Does it matter?

Radical cystectomy and women's sexual health – can we do better?

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