The Effect of the Area Deprivation Index on Surgical Outcomes for Benign Cystectomy

The impact of socioeconomic status (SES) on surgical outcomes is often underrecognized. Benign cystectomy (BC) for nononcologic bladder disease carries high morbidity but remains understudied. We evaluated the effect of SES on postoperative outcomes and healthcare utilization following BC.

We retrospectively reviewed all BCs performed at our institution from 2012 to 2025. Neighborhood-level socioeconomic disadvantage was measured using the area deprivation index (ADI; scale 1-10), with higher scores indicating greater deprivation. Patients were stratified into deciles (ADID). ADI reflects area-level socioeconomic conditions rather than individual-level characteristics and therefore may not capture patient-specific socioeconomic factors. Surgical outcomes, emergency department (ED) utilization, and 90-day readmissions were compared across ADID groups.

Among 183 patients, the median ADI was 5 (IQR 4-8). Preoperative comorbidities, urinary diversion type, operative time, length of stay, and in-hospital complication rates were similar across ADID groups. ED visits and 90-day readmission rates did not differ by SES (p > 0.05). On multivariable analysis, Indiana pouch diversion was associated with higher odds of postoperative complications (OR, 4.2; 95% CI, 1.4-12.8; p < 0.05). Both Indiana pouch (OR, 4.1; 95% CI, 1.3-13.1; p < 0.05) and a neobladder (OR, 3.7; 95% CI, 1.4-9.8; p < 0.05) were associated with a greater likelihood of readmission within 90 days of discharge.

SES, as measured by ADID, was not significantly associated with outcomes or postoperative healthcare utilization. BC carries high morbidity regardless of SES. These findings warrant prospective validation.