Factors That Influence Selectionof Urinary Diversion Among Bladder Cancer Patients in 3 Community-based Integrated...

Area of Science:

• Urology
• Surgical Oncology
• Health Services Research

Background:

• Urinary diversion (UD) selection after cystectomy for bladder cancer involves complex decision-making.
• Understanding predictors of UD choice (ileal conduit, neobladder, continent pouch) is crucial for comparative outcome research.

Purpose of the Study:

• To determine the relative contributions of patient and surgeon factors in predicting the type of urinary diversion selected.
• To inform future research comparing cancer survivor outcomes across different surgical treatments.

Main Methods:

• Retrospective analysis of 991 bladder cancer patients undergoing cystectomy/UD between 2010-2015.
• Mixed-effects logistic regression model incorporating patient demographics, comorbidities, tumor stage, and surgeon characteristics.
• Surgeon variability assessed using intraclass correlation coefficient.

Main Results:

• Patient factors were strong predictors of UD choice, with older age, female sex, lower eGFR, higher comorbidity score, and advanced tumor stage associated with ileal conduit selection.
• Surgeons accounted for significant variability in UD choice, but surgeon-specific factors like volume, training, and tenure did not predict selection.
• Multilevel model with patient factors showed good predictive fit (AUC=0.93).

Conclusions:

• Patient characteristics are the primary drivers for urinary diversion selection in a community setting.
• While surgeons contribute to variability, their clinical training and experience are not key predictors of UD choice.
• Further research should explore non-clinical surgeon factors, such as beliefs and attitudes, influencing UD decisions.