MP11-15 MORBIDITY OF UROLOGICAL SURGICAL PROCEDURES: AN ANALYSIS OF RISK FACTORS AND OUTCOMES FOR EIGHTEEN INDEX PROCEDURES

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2014MP11-15 MORBIDITY OF UROLOGICAL SURGICAL PROCEDURES: AN ANALYSIS OF RISK FACTORS AND OUTCOMES FOR EIGHTEEN INDEX PROCEDURES Hiten Patel, Mark Ball, Jason Cohen, Max Kates, Phillip Pierorazio, and Mohamad Allaf Hiten PatelHiten Patel More articles by this author , Mark BallMark Ball More articles by this author , Jason CohenJason Cohen More articles by this author , Max KatesMax Kates More articles by this author , Phillip PierorazioPhillip Pierorazio More articles by this author , and Mohamad AllafMohamad Allaf More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.430AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is an increased focus on improving quality of care within the United States healthcare system. Most reports on the complications of urological procedures focus on the retrospective experience of a few surgeons performing select operations. We sought to analyze data for a broad range of procedures using the National Surgical Quality Improvement Program (NSQIP) to quantify complication rates, perioperative outcomes, and predictors of complications. METHODS NSQIP (2006-2011) was queried for procedures performed by urologic surgeons. Baseline demographics, American Society of Anesthesiologists (ASA) risk, preoperative risk factors, and outcomes including length of stay (LOS), operative time, death, reoperation, and 21 specific complications were obtained. Procedures were classified based on CPT codes and 18 specific procedures were analyzed. Multivariable logistic regression models assessed risk factors for any complication and for Clavien-Dindo grade 4/5 complication. RESULTS Of 48421 procedures classified by CPT code, a total of 39700 (82%) corresponded to the 18 selected procedures (Figure). As expected, abdominopelvic operations were more morbid than endoscopic, scrotal, incontinence, or prolapse procedures. Cystectomy had the highest morbidity (10.8 days LOS, 3.2% 30-day mortality) with a 56% rate of any complication followed by total nephrectomy (21%), RPLND (20%) and RRP (19%). Amongst non-abdominopelvic procedures, rates were highest for TURBT (11%) and TURP (10%). Overall, older age, increasing ASA class, dependent functional status, and preoperative risk factors including history of COPD [OR 1.2 (1.1-1.4)], steroid use [OR 1.3 (1.0-1.5)], acute kidney injury [OR 2.7 (1.9-3.9)], bleeding risk [OR 1.4 (1.2-1.7)], and >4 units preop transfusion [OR 4.4 (3.4-5.8)] were predictors of any complication. Higher ORs of these same risk factors except bleeding risk were predictive of a Clavien-Dindo grade 4/5 complication. CONCLUSIONS Each procedure has a unique rate and array of complications and baseline benchmarks may help hospitals track deficient areas. Preoperative risk factors may aid in patient selection but also identify populations where quality of care deserves risk-adjustment as the benefit of the operation may still be substantial for the patient. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e101-e102 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Hiten Patel More articles by this author Mark Ball More articles by this author Jason Cohen More articles by this author Max Kates More articles by this author Phillip Pierorazio More articles by this author Mohamad Allaf More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...