Abstract
Background: Iatrogenic ureteral injuries during colorectal surgical procedures are rare. Little is known about their incidence, associated outcomes, and predisposing factors. Objective: The purpose of this study was to examine the trends of iatrogenic ureteral injuries in the United States over a decade, as well as their outcomes and risk factors. Design: This was a retrospective study. Settings: The nationwide inpatient sample from 2001 to 2010 was analyzed. Patients: Included were patients with colorectal cancer, benign polyps, diverticular disease, or inflammatory bowel disease undergoing colorectal surgery. Main Outcome Measures: Trends of iatrogenic ureteral injuries occurring in colon and rectal surgical procedures were examined over a 10-year period. Mortality, morbidity, length of stay and total charge associated with ureteral injuries were analyzed on multivariate analysis. Finally, a predictive model for ureteral injuries was built using patient, hospital, and operative variables. Results: An estimated 2,165,848 colorectal surgical procedures were performed in the United States over the study period, and 6027 ureteral injuries were identified (0.28%). The rate of ureteral injuries was higher in the second half of the decade (2006-2010) compared with the first half (2001-2005; 3.1/1000 vs 2.5/1000; p < 0.001). Ureteral injuries were independently associated with higher mortality (OR, 1.45; p < 0.05), morbidity (OR, 1.66; p < 0.001), longer length of stay (mean difference, 3.65 days; p < 0.001), and higher hospital charges by $31,497 (p < 0.001). Risk factors for ureteral injuries included rectal cancer (OR, 1.85), adhesions (OR, 1.83), metastatic cancer (OR, 1.76), weight loss/malnutrition (OR, 1.08), and teaching hospitals (OR, 1.05). Protective factors included the use of laparoscopy (OR, 0.91), transverse colectomy (OR, 0.90), and right colectomy (OR, 0.43). Limitations: This was a retrospective study from an administrative database. Conclusions: Iatrogenic ureteral injuries are rare complications in colorectal surgery; however, their incidence appears to be rising. Ureteral injuries are associated with higher mortality, morbidity, hospital charge, and length of stay, and their incidence can be predicted by several factors.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 179-186 |
| Number of pages | 8 |
| Journal | Diseases of the Colon and Rectum |
| Volume | 57 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 1 2014 |
| Externally published | Yes |
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Keywords
- Colorectal surgery
- Nationwide inpatient sample
- Outcomes
- Risk-factors
- Trends
- Ureteral injury
- Ureters
ASJC Scopus subject areas
- Gastroenterology
Cite this
Ureteral injuries in colorectal surgery : An analysis of trends, outcomes, and risk factors over a 10-year period in the United States. / Halabi, Wissam J; Jafari, Mehraneh D.; Nguyen, Vinh Q.; Carmichael, Joseph C.; Mills, Steven; Pigazzi, Alessio; Stamos, Michael J.
In: Diseases of the Colon and Rectum, Vol. 57, No. 2, 01.02.2014, p. 179-186.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Ureteral injuries in colorectal surgery
T2 - An analysis of trends, outcomes, and risk factors over a 10-year period in the United States
AU - Halabi, Wissam J
AU - Jafari, Mehraneh D.
AU - Nguyen, Vinh Q.
AU - Carmichael, Joseph C.
AU - Mills, Steven
AU - Pigazzi, Alessio
AU - Stamos, Michael J.
PY - 2014/2/1
Y1 - 2014/2/1
N2 - Background: Iatrogenic ureteral injuries during colorectal surgical procedures are rare. Little is known about their incidence, associated outcomes, and predisposing factors. Objective: The purpose of this study was to examine the trends of iatrogenic ureteral injuries in the United States over a decade, as well as their outcomes and risk factors. Design: This was a retrospective study. Settings: The nationwide inpatient sample from 2001 to 2010 was analyzed. Patients: Included were patients with colorectal cancer, benign polyps, diverticular disease, or inflammatory bowel disease undergoing colorectal surgery. Main Outcome Measures: Trends of iatrogenic ureteral injuries occurring in colon and rectal surgical procedures were examined over a 10-year period. Mortality, morbidity, length of stay and total charge associated with ureteral injuries were analyzed on multivariate analysis. Finally, a predictive model for ureteral injuries was built using patient, hospital, and operative variables. Results: An estimated 2,165,848 colorectal surgical procedures were performed in the United States over the study period, and 6027 ureteral injuries were identified (0.28%). The rate of ureteral injuries was higher in the second half of the decade (2006-2010) compared with the first half (2001-2005; 3.1/1000 vs 2.5/1000; p < 0.001). Ureteral injuries were independently associated with higher mortality (OR, 1.45; p < 0.05), morbidity (OR, 1.66; p < 0.001), longer length of stay (mean difference, 3.65 days; p < 0.001), and higher hospital charges by $31,497 (p < 0.001). Risk factors for ureteral injuries included rectal cancer (OR, 1.85), adhesions (OR, 1.83), metastatic cancer (OR, 1.76), weight loss/malnutrition (OR, 1.08), and teaching hospitals (OR, 1.05). Protective factors included the use of laparoscopy (OR, 0.91), transverse colectomy (OR, 0.90), and right colectomy (OR, 0.43). Limitations: This was a retrospective study from an administrative database. Conclusions: Iatrogenic ureteral injuries are rare complications in colorectal surgery; however, their incidence appears to be rising. Ureteral injuries are associated with higher mortality, morbidity, hospital charge, and length of stay, and their incidence can be predicted by several factors.
AB - Background: Iatrogenic ureteral injuries during colorectal surgical procedures are rare. Little is known about their incidence, associated outcomes, and predisposing factors. Objective: The purpose of this study was to examine the trends of iatrogenic ureteral injuries in the United States over a decade, as well as their outcomes and risk factors. Design: This was a retrospective study. Settings: The nationwide inpatient sample from 2001 to 2010 was analyzed. Patients: Included were patients with colorectal cancer, benign polyps, diverticular disease, or inflammatory bowel disease undergoing colorectal surgery. Main Outcome Measures: Trends of iatrogenic ureteral injuries occurring in colon and rectal surgical procedures were examined over a 10-year period. Mortality, morbidity, length of stay and total charge associated with ureteral injuries were analyzed on multivariate analysis. Finally, a predictive model for ureteral injuries was built using patient, hospital, and operative variables. Results: An estimated 2,165,848 colorectal surgical procedures were performed in the United States over the study period, and 6027 ureteral injuries were identified (0.28%). The rate of ureteral injuries was higher in the second half of the decade (2006-2010) compared with the first half (2001-2005; 3.1/1000 vs 2.5/1000; p < 0.001). Ureteral injuries were independently associated with higher mortality (OR, 1.45; p < 0.05), morbidity (OR, 1.66; p < 0.001), longer length of stay (mean difference, 3.65 days; p < 0.001), and higher hospital charges by $31,497 (p < 0.001). Risk factors for ureteral injuries included rectal cancer (OR, 1.85), adhesions (OR, 1.83), metastatic cancer (OR, 1.76), weight loss/malnutrition (OR, 1.08), and teaching hospitals (OR, 1.05). Protective factors included the use of laparoscopy (OR, 0.91), transverse colectomy (OR, 0.90), and right colectomy (OR, 0.43). Limitations: This was a retrospective study from an administrative database. Conclusions: Iatrogenic ureteral injuries are rare complications in colorectal surgery; however, their incidence appears to be rising. Ureteral injuries are associated with higher mortality, morbidity, hospital charge, and length of stay, and their incidence can be predicted by several factors.
KW - Colorectal surgery
KW - Nationwide inpatient sample
KW - Outcomes
KW - Risk-factors
KW - Trends
KW - Ureteral injury
KW - Ureters
UR - http://www.scopus.com/inward/record.url?scp=84893740668&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84893740668&partnerID=8YFLogxK
U2 - 10.1097/DCR.0000000000000033
DO - 10.1097/DCR.0000000000000033
M3 - Article
C2 - 24401879
AN - SCOPUS:84893740668
VL - 57
SP - 179
EP - 186
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
SN - 0012-3706
IS - 2
ER -