SUFU 2018: Factors Predictive of Prolonged Length of Stay and Unplanned Readmission Following Artificial Urinary Sphincter Surgery
The authors used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2012-2015) to perform a retrospective cohort study of patients with UI who underwent primary or revision AUS placement. Multivariable logistic regression was performed to explore the factors associated with PLOS (≥2 days) and UR within 30 days of surgery.
They found a total of 1085 patients were identified and included in analysis of which 836 (77.1%) underwent primary AUS and 249 (23%) underwent AUS revision. Most patients (894, 82.4%) had no concurrent procedures however cystoscopy was performed in 127 patients (11.7%), IPP in 36 (3.3%), and another procedure in 28 (2.6%) of patients. The median age of patients was 71 years (interquartile range [IQR] 65-76) and median operative time was 86 minutes (IQR 68-112). Patient LOS was 0 days in 216 (19.9%), 1 day in 797 (73.5%), and ≥2 days in 72 (6.6%). Preoperative predictors of PLOS were current smoker within one year, known bleeding disorder, and steroid use. Longer operative times and concurrent primary or revision AUS placement with an inflatable penile prosthesis (IPP) was also found to be associated with PLOS but not with UR. Of all variables, bleeding disorder was the only predictor of UR.
What they found that the smoking status, steroid use, longer operative time, and concurrent IPP placement are associated with PLOS however not associated with readmission following either primary or revision AUS surgery. Patients with bleeding disorders were associated with both PLOS and UR. Preoperative identification of these patient factors may be useful for optimizing patient care.
Presented by: Siobhan Hartigan, MD, Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
Co Authors: Leilei Xia , William Jaffe MD, Thomas Guzzo MD and Robert C. Kovell MD, Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas