Adverse In-hospital Outcomes According to Pelvic Lymph Node Dissection at Partial Cystectomy

Objective: This study was designed to test the association between adverse in-hospital outcomes and pelvic lymph node dissection (PLND) at partial cystectomy (PC) for nonmetastatic bladder cancer (BCa). Methods: We identified patients treated with PC for BCa (National Inpatient Sample 2012–2019). First, estimated annual percentage changes (EAPC) tested temporal trends of PLND at PC. Second, descriptive analyses, propensity score matching (PSM, ratio 1:2) and multivariable logistic regression models (LRMs) were used. Results: Of 1,289 BCa patients treated with PC, 201 (16.0%) underwent PLND. The rates of PLND at PC decreased from 24.8 to 5.4% over the study span (EAPC − 11.3%; p = 0.01). Pelvic lymph node dissection patients were younger (67 vs. 71 years old; p < 0.001), exhibited a lower number of comorbidities (Charlson Comorbidity Index [CCI] 0: 41% vs. 38%; p = 0.006), and were more frequently admitted to teaching (83% vs. 76%; p = 0.03) and large bedsize (69% vs. 57%; p = 0.004) hospitals. After PSM, 201 of 201 (100%) PLND vs. 402 of 1,088 (36.9%) no-PLND at PC patients were included in further analyses. Pelvic lymph node dissection at PC patients only exhibited significantly higher rate of intraoperative complications (9% vs. 3.7%; p = 0.008), but no statistically significant differences in 13 of 14 other categories were recorded (all p values > 0.09). In multivariable LRMs, PLND independently predicted 2.6-fold higher rate of intraoperative complications (p = 0.01). Conclusions: The rate of PLND drastically decreased over time. PLND vs. no-PLND at PC only resulted in a moderate increase in intraoperative complications without differences in 13 other adverse in-hospital outcomes, which included complications, in-hospital mortality, length of stay, and total hospital charges.