MP52-05 ANTERIOR URETHROPLASTY HAS TRANSITIONED TO AN OUTPATIENT PROCEDURE, BUT WITH INCREASED COMPLICATIONS: DATA FROM NSQIP

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INTRODUCTION AND OBJECTIVES: Transitioning surgery from inpatient to outpatient management may potentially decrease cost. Anterior urethroplasty, which has traditionally been performed on an inpatient basis, can be performed as a same-day operation, but outcomes data is lacking. Our study sought to examine the trend in inpatient versus outpatient performance of single stage anterior urethroplasty and to determine outcomes using data from the National Surgical Quality Improvement Program (NSQIP) database. METHODS: A retrospective cross sectional analysis of NSQIP data was performed. Cases of single stage anterior urethroplasty were identified using the ICD-9 procedure code 53410. All cases reported between the years 2006-2013 were identified and postoperative complications were examined. Univariate analysis was performed to determine 30-day complication rates and associated risk factors for both inpatient and outpatient cases. A linear regression model was created for all years with greater than 50 reported cases. RESULTS: A total of 326 anterior urethroplasties were reported over the study period; 222 (68.1%) were performed as inpatient procedures, and 104 (31.9%) were performed on an outpatient basis. The linear regression model shows a significant decrease in inpatient procedures (R1⁄40.91) and a significant increase in outpatient procedures (R1⁄40.91) for the last 3 years of the study period. Mean length of stay following inpatient procedures was 1.8 days. The most common complication was urinary tract infection, which was consistent between inpatient (2.7%) and outpatient (2.9%) procedures. The rate of wound dehiscence, however, was significantly higher among outpatient cases (1.92% vs 0%, p 1⁄4 0.03), although the overall incidence was low. There were no significant differences in the rates of wound infection, bleeding, graft failure, deep vein thrombosis, pneumonia, or sepsis. Resident involvement in surgery was associated with a significantly decreased rate of reoperation (0% vs 9.1% p<0.001). CONCLUSIONS: : In recent years, there has been a significant shift in the performance of anterior urethroplasty toward outpatient management. Regardless of setting, the overall complication rates appear low, however outpatient management was associated with a significantly increased risk of wound dehiscence. Resident involvement was associated with a significantly reduced chance of reoperation. Future work is necessary to determine how to decrease overall cost of single stage urethroplasty without compromising quality of care.