Temporal Trends in Cystostomy Exchanges and Placements: A 2000 -2014 Analysis of the National Inpatient Sample (NIS) and National Emergency Department Sample (NEDS) of the Healthcare Cost and Utilization Project

Sunday, March 5, 2023

3:45 PM – 3:54 PM

Location: Phoenix Convention Center, 225AB

Presenting Author(s)

JN

Jenny Nguyen, BS

Student Author
Emory University School of Medicine

Disclosure information not submitted.

Author/Co-author(s)

JM

John T. Moon, MD

IR/DR Resident Physician
Emory University School of Medicine
MK

Menelaos Konstantinidis, BS, MS

Graduate Student
University of Toronto
Hanzhou (Hanssen) Li, MD

IR/DR Resident Physician
Emory University School of Medicine
Zachary L. Bercu, MD RPVI (he/him/his)

Assistant Division Director, Innovation and Strategy; Associate Professor
Emory University School of Medicine

Disclosure(s):

John T. Moon, MD: No financial relationships to disclose

Hanzhou (Hanssen) Li, MD: No financial relationships to disclose

Zachary L. Bercu, MD RPVI: Terumo Medical Corporation: Speaking and Teaching (Ongoing); XAct Robotics: Advisory Committee or Review Panel Member (Ongoing)

Purpose: Suprapubic urinary catheters have increased in prevalence over indwelling urethral catheters for long-term catheterization due to their greater comfort and ease of management by nursing. However, these catheters have high complication rates, some of which require cystostomy exchange. The purpose of our study was to evaluate the temporal trends in the ratio of cystostomy exchange to cystostomy placements.

Materials and Methods: The National Inpatient Sample (NIS) and the Nationwide Emergency Department Sample (NEDS) of the Healthcare Cost and Utilization Project were queried for available data between 2000-2014. The following corresponding ICD-9 codes, 57.17, 57.18, 57.19, 57.21, and 59.94 were queried between 2000-2014 and included both placements and exchanges. The number of cystostomy exchanges was acquired, and a ratio of exchanges to placements was calculated for both inpatient and emergency settings for each year. For inpatient settings, the ratio acquired was between years 2000-2014. For emergency settings, the ratio acquired was between 2006-2014. A linear regression using ordinary least squares (OLS) was performed for both data sets to estimate the existence of a temporal trend on exchange-to-placement ratios (ETPR).

Results: In the inpatient setting from 2000 to 2014, there was a positive association between year and the ETPR with each year resulting in an average increase in the ETPR of 2.94 x 10^-2 (95% CI: 2.58 x 10^-2– 3.30 x 10^-2; p < 0.05; R²: 0.95). Similarly, in the emergency setting from 2006 to 2014, there was a positive association between year and the ETPR with each year resulting in an average increase in the ETPR of 5.82 x 10^-2 (95% CI: 4.75 x 10^-2 – 6.89 x 10^-2; p< 0.05; R²: 0.94).

Conclusion: The rising ratios of cystostomy exchanges to placements in both the inpatient (2000-2014) and emergency department (2006 – 2014) demonstrate an increasing proportion of exchanges as compared to primary placement of suprapubic cystostomy catheters. The predicted ratios are greater in the emergency as compared to inpatient setting. This trend highlights a growing healthcare burden, which may in part be related to an increasing aging population requiring long-term catheterization. Changes in management of suprapubic catheters or incorporation of novel designs may decrease the burden of rising exchanges.