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Comparing benign to malignant cystectomy: complications, emergency department utilization, readmissions, and
Maxwell Sandberg1, David Thole2, Randall Bissette2
1Wake Forest University School of Medicine, Winston Salem, NC, USA. maxwell.sandberg@advocatehealth.org.
Introduction:
Research has often focused on radical cystectomy for bladder cancer; however, there is an entirely different population, namely those who undergo cystectomy for benign, non-cancerous reasons, which requires attention. The purpose of this study was to compare patients who underwent cystectomy for benign (BC) and malignant (MC) reasons, focusing on complications, emergency department (ED) utilization, readmission, and socioeconomic status (SES).
Methods:
Cystectomies performed at our institution from 2012 to 2025 were reviewed. Patients were divided based on indication into BC versus MC (for bladder cancer with pathologic confirmation). Non-oncologic cystectomies were either for neurogenic bladder, interstitial cystitis/bladder pain syndrome, or "other reasons." Complications were divided into in-house immediately following cystectomy prior to discharge and those occurring within 90 days of discharge. The Memorial Sloan Kettering Cancer Center classification system of cystectomy complications was used to qualify complications. ED utilization and readmissions were charted within the first 90 days of discharge. Area Deprivation Index (ADI) scores, which assign rankings to SES for neighborhoods, were used as a surrogate for patient SES. BC and MC patients were compared.
Results:
569 patients were included in the analysis (183 BC and 386 MC). Urinary diversion choice differed between groups, with more cutaneous ureterostomies in MC patients and Indiana Pouches in BC patients (p < 0.001). In-house complications were significantly greater in the benign cohort (51%) compared with the malignant cohort (36%; p < 0.001). ED utilization within 90 days of discharge was greater in BC (51%) relative to MC (34%; p < 0.001) patients, and BC patients were more likely to visit the ED with no readmission (p < 0.001). 69 (40%) patients were readmitted in the BC group, and 67 (17%; p < 0.001) patients were readmitted in the MC group. ADI scores 1-4 (higher SES) were more common in BC patients (p = 0.012).
Conclusions:
BC patients have greater rates of healthcare utilization compared to those undergoing MC. While recognizing these patient populations are not the same, the causes of these differences call for additional investigation.
