MP38-10 CHARACTERIZATION OF SURGICAL INPATIENT CARE FOR UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP38)1 May 2024MP38-10 CHARACTERIZATION OF SURGICAL INPATIENT CARE FOR UPPER TRACT UROTHELIAL CARCINOMA Ekamjit S. Deol, Daniel D. Joyce, and Nicholas L. Kavoussi Ekamjit S. DeolEkamjit S. Deol , Daniel D. JoyceDaniel D. Joyce , and Nicholas L. KavoussiNicholas L. Kavoussi View All Author Informationhttps://doi.org/10.1097/01.JU.0001008700.92603.b1.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Though traditionally treated with extirpative surgery, current guidelines support endoscopic management of upper tract urothelial carcinoma (UTUC) for low-risk or low volume high-risk disease. Endoscopic treatment is usually performed in an outpatient setting. However, treatment patterns for UTUC are poorly characterized. We sought to characterize treatment patterns of UTUC in the inpatient setting. METHODS: The National Inpatient Sample (NIS) was queried for patients with a diagnosis of UTUC and either extirpative (nephroureterectomy, ureterectomy, partial nephrectomy) or endoscopic treatment for the 5 years succeeding the 2016 change to ICD-10. We describe current patterns of inpatient treatment, patient demographics, Elixhauser comorbidity scores, hospital charges, complications, and lengths of stay (LOS). All analyses were conducted using NIS survey weighting to provide national level estimates per NIS sampling criteria. Univariable and multivariable logistic regressions were used to identify characteristics associated with postoperative complications. RESULTS: From 2016-2020, there were 27,825 inpatient surgical treatments performed for UTUC. Of these, 2815 (10%) were endoscopic and 25,010 (90%) were extirpative surgeries. The proportion of patients undergoing endoscopic treatment for UTUC remained stable throughout the study period (9-11%). Compared to patients undergoing extirpative treatment, those undergoing endoscopic treatment were older (75 vs. 72 yrs, p<0.01) and had higher Elixhauser comorbidity scores (3.6 vs. 2.6, p<0.01). Median inpatient charges were lower for endoscopic surgery compared to extirpative treatment ($53,675 vs. $70,351, p<0.01), despite similar lengths of stay (4 days). On multivariable analysis endoscopic procedures were associated with higher odds of any complication (OR: 2.4, p<0.01, Fig). CONCLUSIONS: In this modern cohort, endoscopic surgery requiring subsequent hospitalization was consistently utilized for patients with UTUC, especially for older patients with higher comorbidity. Despite a higher likelihood of complications and equivalent hospital stay, costs remained significantly lower for endoscopic compared to extirpative surgery. These findings support the use of non-extirpative management for UTUC in patients who may not be fit for nephroureterectomy. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e644 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ekamjit S. Deol More articles by this author Daniel D. Joyce More articles by this author Nicholas L. Kavoussi More articles by this author Expand All Advertisement PDF downloadLoading ...