Comparison of 90-day morbidity and mortality between ileal conduit and orthotopic neobladder following radical cystectomy in a large multi-institutional database: The Canadian CBCIS experience

INTRODUCTION: In patients undergoing radical cystectomy, ileal conduit (IC) urinary diversions are more frequently carried out than orthotopic neo-bladder reconstructions (ONB). Patients selected for IC likely have more comorbidities, advanced disease, and older age, with many being poor candidates for ONB; ONB often ends up being selected by younger and healthier patients. Differences in complications experienced by IC and ONB patients may be due to differences between patients or urinary diversions. To guide patient counseling and care, we aimed to assess 90-day complications and mortality for patients undergoing either procedure in a large, contemporary, Canadian cohort. METHODS: Patient information was obtained from the Canadian Bladder Cancer Information System (CBCIS), encompassing 14 academic Canadian centers. Patients who underwent radical cystectomy between February 2015 and September 2023 were included. Ninety-day complications were analyzed according to the Clavien-Dindo severity scale. Perioperative parameters and 90-day mortality were compared between IC and ONB diversion. We used rank-sum and Chi-squared exact tests as exploratory statistic. Unconditional logistic regression was used to evaluate the association between IC and ONB complications. RESULTS: Of 2161 patients, 1799 (83%) received an IC and 362 (16%) an ONB. Patients were followed for a median of 235 days (interquartile range [IQR] 486). The median age was 69 years (IQR 14). The age-adjusted Charlson comorbidity index (aCCI) was significantly higher in the IC group (median [IQR] 5 [2] vs. 4 [2], p<0.001). The 90-day complication rate was 46% and the 90-day mortality rate was 4.3% for the entire cohort. On multivariable logistic regression, the risk of overall complications was significantly higher in the ONB than in the IC group (odds ratio 2.2, 95% confidence interval 1.7-2.8, p<0.001). Ninety-day mortality was 4.9% in the IC group and 0.82% in the ONB group. CONCLUSIONS: In this multi-institutional cohort, patients with ONB had higher odds of perioperative complications; however, there was no difference in higher-severity complications between diversions.