MP34-20 SEVERE POST-OPERATIVE COMPLICATIONS ARE RARE IN PATIENTS WITH URINARY-PUBIC SYMPHYSIS FISTULAE AND PUBIC BONE OSTEOMYELITIS (UPF-OM) UNDERGOING EXTIRPATIVE SURGERY; DATA FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP34-20 SEVERE POST-OPERATIVE COMPLICATIONS ARE RARE IN PATIENTS WITH URINARY-PUBIC SYMPHYSIS FISTULAE AND PUBIC BONE OSTEOMYELITIS (UPF-OM) UNDERGOING EXTIRPATIVE SURGERY; DATA FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM Jordan Foreman, Kevin Krughoff, William Eward, Edward Hendershot, Christopher Mantyh, and Andrew Peterson Jordan ForemanJordan Foreman More articles by this author , Kevin KrughoffKevin Krughoff More articles by this author , William EwardWilliam Eward More articles by this author , Edward HendershotEdward Hendershot More articles by this author , Christopher MantyhChristopher Mantyh More articles by this author , and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003268.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with urinary-pubic symphysis fistulae and resultant pubic bone osteomyelitis (UPF-OM) are riddled with infections prior to extirpative surgery, our prior research noted 91.7% of patients had positive bone cultures at time of surgery. Our pathway requires holding antibiotics for 2 weeks prior to surgery and not administering IV perioperative antibiotics until the bone is removed at the time of extirpative treatment. This study aims to evaluate the rates of post-operative surgical infections and complications after extirpative surgery for UPF-OM. METHODS: Using the NSQIP database, 36 patients undergoing extirpative surgery for UPF-OM were collected between 2016-2021. Pre- and post-operative characteristics and outcomes were evaluated. At our institution patients with UPF-OM undergo a standard workup and treatment pathway including MRI of pelvis confirming osteomyelitis, pre-operative nutritional labs, and optimization of modifiable risk factors. We involve a multi-disciplinary team including urology, orthopedics, infectious disease, plastic surgery, colorectal surgery if concurrent rectourethral fistula, and acute pain service. RESULTS: The median age at time of surgery was 74.32 years (68.46, 78.28). Baseline patient characteristics included history of radiation in all patients, 4 (11.11%) had a history of tobacco use within 1 year, diabetes 10 (27.78%), median albumin 3.4 (3.2, 3.6), and a median BMI of 27.1 (24.2, 30.88). The median operating room time was 371 minutes (344.5, 408) and the median length of hospitalization was 8 days (7, 10). 6 (16.7%) patients had readmissions related to surgery including 1 small bowel obstruction managed conservatively, 2 readmissions for infection, 2 for dehydration, and 1 for anemia/presyncope. No patients had a bowel anastomotic leak, ureteroenteric leak, or rectal injury. During admission no patients had surgical site infections, deep surgical site infections, urinary tract infections, or sepsis/SIRS at 48 hours. CONCLUSIONS: The rates of severe post-operative complications in extirpative surgery for UPF-OM are low. These findings are surprising given the complexity of the disease process and underlying infected/contaminated field inherent to UPF-OM. Given our pathway that withholds antibiotics until late in the extirpative procedure the rates of infection are exceedingly low and were only present at delayed readmissions. Source of Funding: Boston Scientific Fellowship Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e467 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jordan Foreman More articles by this author Kevin Krughoff More articles by this author William Eward More articles by this author Edward Hendershot More articles by this author Christopher Mantyh More articles by this author Andrew Peterson More articles by this author Expand All Advertisement PDF downloadLoading ...