Pd38-05 determinants of Risk-Aligned Bladder Cancer Surveillance - Mixed-Methods Evaluation Using the Tailored Implementation for Chronic Diseases Framework

Abstract

steadily increasing. A diagnosis of CKD/ESRD has been associated with adverse surgical outcomes across numerous procedures. However, few studies have quantified the prevalence and perioperative safety risks of patients with CKD/ESRD undergoing urological surgery. The current study assesses the impact of CKD/ ESRD on perioperative outcomes such as length of stay (LOS), 30and 90-day readmission, and mortality at 365 days after major urological surgery in New York State.METHODS: Using the New York Statewide Planning and Research Cooperative System (SPARCS) database, all patients undergoing the 4 most common major urological operations -radical prostatectomy (RP), radical cystectomy (RC), partial nephrectomy (PN), and radical nephrectomy (RN) -were identified from 2009 to 2015. Patients were divided into non-CKD, mild CKD, moderate CKD and severe CKD/ESRD groups based on diagnosis codes.RESULTS: A total of 54,625 cases were identified from 2009-2015. The proportion of patients who had either CKD or ESRD increased across all procedures over the study period. CKD/ESRD (Fig 1 A/B) were independently associated with increased LOS, 30-day, and 90-day readmission in RP and RN. Likewise, renal dysfunction was associated with increased LOS in PN, and increased 90-day readmission in RC. Finally, ESRD was associated with increased mortality at one year for RC, PN and RN (OR 2.52, 8.54, 1.63). Stratification of renal dysfunction revealed that moderate and severe CKD/ESRD were the most significant predictors of worse perioperative outcomes across all procedures.CONCLUSIONS: This study is the largest real-world cohort of patients with CKD/ESRD who underwent major urological operations. Across all 4 procedures, patients with CKD/ESRD had significantly greater risk of adverse outcomes. Despite this, the number of these patients presenting for urological procedures continues to rise. As the global demographics of urological patients continue to evolve, urologists must be aware of the untoward patient safety risks associated with renal dysfunction and equipped to care for this increasingly complex population.