Resident Physician Thomas Jefferson University Hospital
Introduction: Appendicovesicostomy (AV) or augmentation enterocystoplasty (AE) for neurogenic bladder (NB) are infrequently performed in adult patients. Outcomes and safety data have been limited to case series. Here, we aim to better elucidate the patient demographics and surgical outcomes for AV and AE using the National Surgical Quality Improvement Project (NSQIP). Methods: AV and AE for NB were identified in NSQIP from 2006-2020 using CPT and ICD codes, and miscoded cases were filtered. Patients with concurrent radical cystectomy, pelvic exenteration, or continent urinary diversion/neobladder CPTs were excluded. Patients were then grouped by whether they had AV, AE, or both AV+AE. Patient baseline characteristics and 30-day outcomes were calculated and described. Results: 131 cases (39 AV, 72 AE, and 20 AV+ AE) of AV and/or AE for neurogenic bladder were identified. Patients undergoing these procedures were young (mean age of 38), mostly female (66%), and mostly white (73%). The most common medical comorbidities were hypertension (21.4%) and diabetes (8.4%). Of note, 9.2% of patients had preoperative wound infections and 5.6% were chronically on steroids. The cohort had significant surgical risk factors; 44% of patients were either partially or totally functionally dependent, and 73% had an ASA class of 3 (severe disturbance) or higher. 24% of patients had a minor 30-day complication, most commonly urinary tract infection (11.5% overall, 10.3% in AV, 13.9% in AE, and 5.0% in AV+AE), superficial surgical site infection (9.2% overall, 10.3% in AV, 8.3% in AE, and 10.0% in AV+AE), pneumonia (3.1% overall, 0.0% in AV, 4.2% in AE, and 5.0% in AV+AE), or bleeding requiring transfusion (3.1% overall, 2.6% in AV, 2.8% in AE, and 5.0% in AV+AE). 13% of patients had a major 30-day complication, most commonly sepsis (6.1% overall, 2.6% in AV, 9.7% in AE, and 0.0% in AV+AE) or pulmonary embolism (2.3% overall, 2.6% in AV, 1.4% in AE, and 5.0% in AV+AE). The 30-day reoperation rate was 2.8% in AEs resulting in a total of 1.5% of cases. 30-day readmission rate was 15.7% overall with 10.5% AVs, 23.1% AEs, and no AV+AEs returning to the hospital. There were no recorded 30-day mortalities. Conclusions: This is the largest study done on AV and AE. These procedures had high complication and readmission rates, which may in part be due to preoperative patient risk factors. Of note, our average patient age and complication rate were lower than previously published studies from NSQIP which may reflect our filtering of mislabeled cases. Further studies are needed to better characterize these patients. SOURCE OF Funding: n/a
