MP17-01 IS A PREOPERATIVE TYPE AND SCREEN REQUIRED IN PATIENTS UNDERGOING COMMON UROLOGICAL PROCEDURES? A COST-BENEFIT ANALYSIS

Abstract

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures I (MP17)1 Sep 2021MP17-01 IS A PREOPERATIVE TYPE AND SCREEN REQUIRED IN PATIENTS UNDERGOING COMMON UROLOGICAL PROCEDURES? A COST-BENEFIT ANALYSIS Joshua Volin, Patrick Herndon, Aviv Spillinger, Patrick Karabon, James Blumline, Deanna Tran, Craig Fletcher, and Jason Hafron Joshua VolinJoshua Volin More articles by this author , Patrick HerndonPatrick Herndon More articles by this author , Aviv SpillingerAviv Spillinger More articles by this author , Patrick KarabonPatrick Karabon More articles by this author , James BlumlineJames Blumline More articles by this author , Deanna TranDeanna Tran More articles by this author , Craig FletcherCraig Fletcher More articles by this author , and Jason HafronJason Hafron More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002002.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Many institutions rely on historical data to guide preoperative type and screen (T/S) requirements. Our objective was to evaluate the cost-effectiveness of obtaining preoperative T/S for common urological procedures and determine patient and hospital factors associated with receiving blood transfusions. METHODS: Retrospective database analysis of the 2006-2015 National (Nationwide) Inpatient Sample (NIS) was performed to identify patients undergoing a variety of urological procedures where T/S is generally obtained. A total of 4,113,144 cases were identified. Transfusion rates were then determined from NIS data, and multivariate regression analyses was used to identify factors associated with transfusions. A cost-effectiveness analysis was performed to determine the incremental cost-effectiveness ratio (ICER) of obtaining preoperative T/S to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500. RESULTS: On multivariate modeling, all Elixhauser comorbidities with the exception of obesity were significant associated with transfusion Some examples included chronic blood loss anemia (OR, 6.56, 95% CI, 6.24-6.89), coagulopathy (OR, 2.04; 95% CI, 1.96-2.12), diabetes (OR, 1.26; 95% CI, 1.19-1.33), liver disease (OR, 1.20; 95% CI, 1.13-1.29), pulmonary circulation disorders (OR, 1.38; 95% CI, 1.30-1.47), and metastatic cancer (OR, 2.69; 95% CI 2.54-2.85) (p <0.01 for all). The ICER of preoperative T/S for radical prostatectomy (transfusion rate=3.88%) and penile implants (transfusion rate=0.91%) were $1,607 and $7,709 per ERT prevented, respectively. One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative T/S. CONCLUSIONS: Routine preoperative T/S for radical prostatectomy and penile implants does not represent a cost-effective practice for these surgeries using nationally representative data. A selective T/S policy for high risk patients may reduce costs. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e308-e308 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Volin More articles by this author Patrick Herndon More articles by this author Aviv Spillinger More articles by this author Patrick Karabon More articles by this author James Blumline More articles by this author Deanna Tran More articles by this author Craig Fletcher More articles by this author Jason Hafron More articles by this author Expand All Advertisement Loading ...