Effect of sex on adverse in-hospital outcomes after radical cystectomy according to urinary diversion type

Objective: To test for differences in adverse in-hospital outcomes between females vs. males after radical cystectomy (RC) according to specific urinary diversion type (neobladder vs. ileal conduit). Methods: Patients were identified within the National Inpatient Sample (NIS 2000–2019). Propensity score matching (PSM, 1:2 ratio) based on sex (female: male) and multivariable logistic regression models (LRMs) were applied separately to the neobladder and ileal conduit cohorts. Complications were assessed as immediate postoperative events recorded during the index hospitalization, as the NIS database does not include data beyond discharge. Results: Of 1,899 RC patients with neobladder, 209 (11.0%) were female vs. 3,823 (20.3%) were female of 18,777 RC patients with ileal conduit. After 1:2 PSM, 209 of 209 (100%) female neobladder vs. 418 of 1,690 (24.7%) male neobladder patients were included. Within the neobladder cohort, in multivariable LRMs, female sex independently predicted higher rates of blood transfusions (multivariable odds ratio [MOR] 1.7). Conversely, after 1:2 PSM, 3,823 of 3,823 (100%) female ileal conduit vs. 7,646 of 14,954 (51.1%) male ileal conduit patients were included. Within the ileal conduit cohort, in multivariable LRMs, female sex independently predicted higher rates of blood transfusions (MOR 1.5), overall postoperative complications (MOR 1.1), pulmonary complications (MOR 1.1), and hospital stay ≥ 75th percentile (MOR 1.1), but lower rates of wound (MOR 0.7) and gastrointestinal (MOR 0.8) complications. Conclusions: Female sex affects adverse in-hospital outcomes after RC differently based on urinary diversion type. The adverse effect of female sex is much more pronounced in ileal conduit than in neobladder patients.