MP41-17 THE ELDERLY PYELOPLASTY: IS IT AS SAFE AS WE THINK? DATA FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-17 THE ELDERLY PYELOPLASTY: IS IT AS SAFE AS WE THINK? DATA FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM Cooper Benson*, Mahmoud I. Khalil, Mahip Acharya, Nalin Payakachat, Rodney Davis, Omer Raheem, and Ehab Eltahawy Cooper Benson*Cooper Benson* More articles by this author , Mahmoud I. KhalilMahmoud I. Khalil More articles by this author , Mahip AcharyaMahip Acharya More articles by this author , Nalin PayakachatNalin Payakachat More articles by this author , Rodney DavisRodney Davis More articles by this author , Omer RaheemOmer Raheem More articles by this author , and Ehab EltahawyEhab Eltahawy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pyeloplasty remains the most effective surgical treatment for clinically significant and symptomatic ureteropelvic junction obstruction (UPJO). In contemporary practice, Lap/robotic assisted pyeloplasty (Lap/RAP) has largely replaced open pyeloplasty (OP), thus expanding patient selection criteria to include elderly and comorbid patients. We sought to evaluate the short term complications after OP and Lap/RAP in patients ≥70 years old versus 18-69 years old. METHODS: A retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database was performed for all patients undergoing Lap/RAP and OP between 2006 and 2016 (CPT codes: 50544, 50405, 50540, 50400) in adult patients ≥18 years. We compared preoperative characteristics and short term complications in patients ≥70 years old versus 18-69 years old. Statistical analysis was performed using SAS 9.4. Chi-squared test and student’s t-test were used with p< 0.05 defining statistical significance. RESULTS: We identified a total of 1,850 patients, 1,632 between 18-69 years, mean age 43.4 years, (311 OP and 1,321 Lap/RAP) and 218 in those ≥70 years, mean age 75.7 years (47 OP and 171 Lap/RAP). There was no significant difference in race, body mass index, operating time, unplanned reoperations and readmission between the two age groups. American Society of Anesthesiologists (ASA) classification differed significantly between the two age groups with a majority of patients ≥70 years with ASA III-V (p<0.001). Additionally, elderly group had longer hospitalizations (4.5 vs 3.6 days, p=0.002) and more 30-day complications (12.8% vs 6.8%, p=0.002) than the younger group, with higher rates of intraoperative transfusion (4.1% vs.1.5%) and post-operative UTI (6.4% vs. 3.7). OP was associated with more short-term complications (14.5% vs. 5%, p<0.001) and unplanned reoperations (3.2% vs. 1.5%, p=0.045) in the younger group. Whereas Lap/RAP in the elderly group was associated with shorter hospital stay (3.1 vs. 5.7 days, p=0.001), fewer readmissions (4.1% vs. 12.8%, p=0.037) but similar complications, operative time and ASA class compared to OP. CONCLUSIONS: Regardless of the used approach, pyeloplasty in elderly (≥70 years) patients continue to require longer hospitalization and sustain higher complication rate compared to their younger counter parts. Compared to OP, Lap/RAP in elderly offers shorter hospitalization and fewer readmissions with comparable complication rate. Future prospective study should be performed to confirm these findings, delineate patient selection criteria and ultimately long-term functional outcomes. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e601-e601 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cooper Benson* More articles by this author Mahmoud I. Khalil More articles by this author Mahip Acharya More articles by this author Nalin Payakachat More articles by this author Rodney Davis More articles by this author Omer Raheem More articles by this author Ehab Eltahawy More articles by this author Expand All Advertisement PDF downloadLoading ...