Susan MacDonald1, Devin Haddad2, Abraham Choi3, Marc Colaco4, Ryan Terlecki4. 1. Department of Urology, Penn State Hershey Medical Center, Hershey, PA. Electronic address: smacdonald@hmc.psu.edu. 2. Ohio State University Wexner Medical Center, Columbus, OH. 3. Wake Forest School of Medicine, Winston-Salem, NC. 4. Wake Forest School of Medicine, Winston-Salem, NC; Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC.
Abstract
OBJECTIVE: To analyze the trend in inpatient vs outpatient performance of anterior urethroplasty and examine outcomes using data from the National Surgical Quality Improvement Program database. METHODS: A retrospective cross sectional analysis was performed using the National Surgical Quality Improvement Program database. Cases of single-stage anterior urethroplasty from 2006 to 2013 were identified using the International Classification of Diseases, Ninth Revision, procedure code 53410. Univariate analysis was performed to compare 30-day complication rates for inpatient and outpatient cases. A linear regression model was created for all years with greater than 50 reported cases. RESULTS: A total of 326 anterior urethroplasties were reported; 222 (68.1%) were inpatient procedures, and 104 (31.9%) were outpatient procedures. The most common complication, urinary tract infection, was consistent between inpatient (2.7%) and outpatient (2.9%) procedures. The rate of wound dehiscence was significantly higher among outpatient cases (1.92% vs 0%, P = .03). There were no significant differences in the rates of wound infection, bleeding, graft failure, deep vein thrombosis, pneumonia, or sepsis. The linear regression model shows a significant increase in outpatient procedures (R2 = 0.91) and equivalent decrease in inpatient procedures (R2 = 0.91) for the last 3 years of the study period. Resident involvement was associated with a decreased rate of reoperation (0% vs 8.3% P <.001). CONCLUSION: There has been a shift in the performance of anterior urethroplasty toward outpatient management. Overall, complication rates appear low. Future research is necessary to determine how to decrease overall cost of single-stage urethroplasty without compromising quality of care.
OBJECTIVE: To analyze the trend in inpatient vs outpatient performance of anterior urethroplasty and examine outcomes using data from the National Surgical Quality Improvement Program database. METHODS: A retrospective cross sectional analysis was performed using the National Surgical Quality Improvement Program database. Cases of single-stage anterior urethroplasty from 2006 to 2013 were identified using the International Classification of Diseases, Ninth Revision, procedure code 53410. Univariate analysis was performed to compare 30-day complication rates for inpatient and outpatient cases. A linear regression model was created for all years with greater than 50 reported cases. RESULTS: A total of 326 anterior urethroplasties were reported; 222 (68.1%) were inpatient procedures, and 104 (31.9%) were outpatient procedures. The most common complication, urinary tract infection, was consistent between inpatient (2.7%) and outpatient (2.9%) procedures. The rate of wound dehiscence was significantly higher among outpatient cases (1.92% vs 0%, P = .03). There were no significant differences in the rates of wound infection, bleeding, graft failure, deep vein thrombosis, pneumonia, or sepsis. The linear regression model shows a significant increase in outpatient procedures (R2 = 0.91) and equivalent decrease in inpatient procedures (R2 = 0.91) for the last 3 years of the study period. Resident involvement was associated with a decreased rate of reoperation (0% vs 8.3% P <.001). CONCLUSION: There has been a shift in the performance of anterior urethroplasty toward outpatient management. Overall, complication rates appear low. Future research is necessary to determine how to decrease overall cost of single-stage urethroplasty without compromising quality of care.
Authors: Robert Pickard; Beatriz Goulao; Sonya Carnell; Jing Shen; Graeme MacLennan; John Norrie; Matt Breckons; Luke Vale; Paul Whybrow; Tim Rapley; Rebecca Forbes; Stephanie Currer; Mark Forrest; Jennifer Wilkinson; Elaine McColl; Daniela Andrich; Stewart Barclay; Jonathan Cook; Anthony Mundy; James N'Dow; Stephen Payne; Nick Watkin Journal: Health Technol Assess Date: 2020-11 Impact factor: 4.014
Authors: Maxim J McKibben; Michael T Davenport; Partho Mukherjee; Nabeel A Shakir; Mary L West; Joceline S Fuchs; Ellen E Ward; Rachel L Bergeson; Jeremy M Scott; Allen F Morey Journal: Transl Androl Urol Date: 2020-02