MP17-16 OPERATIVE DURATION DURING UROLOGY ONCOLOGIC CASES AS INDEPENDENT PREDICTOR OF INCREASED POSTOPERATIVE HEALTHCARE UTILIZATION

Abstract

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures I (MP17)1 Sep 2021MP17-16 OPERATIVE DURATION DURING UROLOGY ONCOLOGIC CASES AS INDEPENDENT PREDICTOR OF INCREASED POSTOPERATIVE HEALTHCARE UTILIZATION Jacqueline Morin, Amber Bettis, and Andrew Harris Jacqueline MorinJacqueline Morin More articles by this author , Amber BettisAmber Bettis More articles by this author , and Andrew HarrisAndrew Harris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002002.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent literature across a spectrum of surgical specialties has identified operative duration (OD) as an important predictor of increased postoperative complications and costs. In Urology, oncologic cases including minimally-invasive partial nephrectomy (MIPN), minimally-invasive prostatectomy (MIP), and cystectomy (Cx) rank among the most common major cases performed by urologists. Few studies have examined modifiable risk factors for postoperative healthcare resource utilization (HRU) among these particular cases. The aim of this study was to assess if OD is a predictor of HRU in this population. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was filtered for MIPN, MIP, and Cx from 2012-2018. Patient characteristics, presence of comorbid conditions, postoperative complications, and HRU were recorded. HRU was defined as prolonged length of stay (LOS), unplanned readmission <30 days after surgery, and discharge destination other than home. These factors were compared against OD using multivariate regression to identify independent predictors of HRU. RESULTS: 18,904 MIPN, 50,807 MIP, and 12,451 Cx were included. For MIPN, HRU was seen in 13.9% of cases <1.75h, increasing to 36.2% in OD >4.5h (p <0.001). For MIP, HRU was seen in 10.6% of OD <2h, increasing to 32.2% for OD >4.9h (p <0.001). For Cx, up to 57% of those with OD >8.5h required HRU compared to 42.1% for OD <3.3h (p <0.001). Using multivariate analyses, OD was found to be an independent predictor for increased HRU for all procedures regardless of patient characteristics or comorbidities. For MIPN, OD >4.5h had a nearly 3.5-fold increased use of HRU compared to shorter OD (p <0.001). For MIP, OD >5h carried a 3.7-fold increased use of HRU (p <0.001). For Cx, OD >8.5h demonstrated a 2-fold increased use of HRU (p <0.001). Figure 1. CONCLUSIONS: OD during MIPN, MIP, and Cx is an independent predictor of increased HRU irrespective of patient comorbidities. Patients with OD >4.5h for MIPN, >5h for MIP, and >8.5h for Cx have 3.5-fold, 3.7-fold, and 2-fold increased risk of HRU, respectively. This information can be used in the post-operative setting to anticipate patient needs and ultimately improve patient outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e314-e314 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacqueline Morin More articles by this author Amber Bettis More articles by this author Andrew Harris More articles by this author Expand All Advertisement Loading ...