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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. M.D.1; Jafari, Mehraneh D. M.D.1; Nguyen, Vinh Q. Ph.D.2; Carmichael, Joseph C. M.D.1; Mills, Steven M.D.1; Pigazzi, Alessio M.D., Ph.D.1; Stamos, Michael J. M.D.1

Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0000000000000033
Original Contributions: Benign Colorectal Disease
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.

Author Information

1Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California

2Department of Statistics, University of California, Irvine, Irvine, California

Financial Disclosure: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Phoenix, AZ, April 27 to May 1, 2013.

Correspondence: Michael J. Stamos, M.D., Department of Surgery, University of California, Irvine, 333 City Blvd West, Suite 700, Orange, CA 92868. E-mail: mstamos@uci.edu

© 2014 The American Society of Colon and Rectal Surgeons