LOCALIZING URETERAL CATHETERS FOR LEFT-SIDED COLECTOMY AND PROCTECTOMY: DO THE RISKS JUSTIFY THE BENEFITS?
S Dolejs, M Nicolas, D Maun, J Waters, B Tsai, F Lane
Prior literature has demonstrated that ureteral catheters do not prevent ureteral injury but may aid in the identification of ureteral injury. A recent National Surgical Quality Improvement Project (NSQIP) study showed that ureteral catheters may reduce ureteral injury when all colectomies were included. This study seeks to establish the role and morbidity of ureteral catheters in left-sided colectomies and proctectomies.
The colectomy- or proctectomy-targeted NSQIP participant use file from 2012 to 2018 were queried. Left-sided colectomies were included. Emergent procedures were excluded. Prophylactic ureteral catheterization and ureteral injury was defined by CPT codes. A robust 2:1 propensity score matching was used to compare patients with ureteral catheterization to those without using preoperative comorbidities in NSQIP, operative complexity (defined by revenue value units (RVUs) for all initial procedures), indication for procedure, and operative approach. A multivariable logistic regression was then performed to determine risk factors for ureteral injury.
Prior to propensity score matching, there were 8,419 patients with ureteral catherization and 128,021 patients without. After matching, 8,112 patients with ureteral catheterization were matched to 16,224 patients without ureteral catheterization. Baseline characteristics were similar. There was not a statistically significant difference in ureteral injury between the groups (0.7% with stent vs 0.9% without stent, p-value=0.07). Ureteral catheters were associated with an increased overall morbidity due to higher rates of renal insufficiency (AKI) and post-operative ileus, which may have been driven by a 46 minute longer median operative time in the ureteral catheterization group (Table). Increasing body mass index (p<0.01), operations for diverticular disease (p<0.01), conversion to open (p<0.01), and increasing operative complexity (p<0.01) were all associated with ureteral injury.
Ureteral catheterization was not associated with decreased rates of ureteral injury when evaluating all left-sided colectomies. Ureteral catherization came at a cost of increased operative time and higher rates of AKI and ileus. High-risk patients for ureteral injury include those with obesity, operations for diverticular disease, those requiring conversion to open, and more complex operations. Selective prophylactic ureteral catheterization may be warranted in these settings.
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