PD28-08 SAGACITY OF SAME DAY DISCHARGE: INCIDENCE AND TIMING OF POSTOPERATIVE ADVERSE EVENTS FOLLOWING MINIMALLY INVASIVE UROLOGIC SURGERY

Abstract

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety I (PD28)1 Sep 2021PD28-08 SAGACITY OF SAME DAY DISCHARGE: INCIDENCE AND TIMING OF POSTOPERATIVE ADVERSE EVENTS FOLLOWING MINIMALLY INVASIVE UROLOGIC SURGERY Kevin Ginsburg, Alberto Andres Castro Bigalli, Rosalia Viterbo, Richard Greenberg, Robert Uzzo, David Chen, Marc Smaldone, Alexander Kutikov, and Andres Correa Kevin GinsburgKevin Ginsburg More articles by this author , Alberto Andres Castro BigalliAlberto Andres Castro Bigalli More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Robert UzzoRobert Uzzo More articles by this author , David ChenDavid Chen More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , and Andres CorreaAndres Correa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002029.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In efforts to judiciously utilize resources and contain cost, there has been increasing efforts to reduce postoperative length of stay, resulting in several groups promoting same day discharge (SDDC) for patients undergoing minimally invasive prostatectomy (MIP) and minimally invasive partial nephrectomy (MIpN). We aimed to 1) describe the incidence and timing of adverse events, readmission, reoperation and death and 2) compare the incidence of these outcomes for patients undergoing SDDC and non-SDDC following MIP and MIpN. METHODS: We review the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for patients undergoing MIP and MIpN from 2015 to 2019. The primary outcomes was to describe the incidence of adverse events, readmission, reoperation, and death and the timing of these outcomes after surgery. Additionally, we compared the incidence of outcomes of interest between patients undergoing same day discharge (SDDC) vs. non-SDDC using the chi-squared test. RESULTS: A total of 64,975 patients underwent MIP (46,869) and MIpN (18,106), of which 650 (1%) had a SDDC. SDDC patients tended to be younger (median 61, IRQ 55-68) compared with non-SDDC patients (median 63, IRQ 57-68, p<0.001). We noted 4,593 complications in 3,560 (5.5%) patients, including 1,057 (1.6%) blood transfusions, 129 (0.2%) myocardial infarctions, 86 (0.1%) cardiac arrests, 433 (0.7%) DVTs, 359 (0.6%) PEs, 55 (0.1%) CVAs, 167 (0.3%) patients being intubated, 99 (0.2%) remaining intubated >48hrs after surgery, 360 (0.6%) patients developing sepsis, 81 (0.1%) cases of septic shock, 280 (0.4%) cases of pneumonia, 1,299 (2.0%) UTIs and 87 deaths (0.1%). Compared with non-SDDC patients, SDDC patients had similar incidence of any complication (5.2% vs. 5.4%, p=0.830), reoperation (0.9% vs. 1.3%, p=0.372), readmission (3.5% vs. 4.4%, p=0.268), or death (0.16% vs. 0.13%, p=0.836). Regarding the timing of adverse events, 984/1057 (93%) blood transfusions, 59/129 (46%) myocardial infarctions, 40/86 (47%) cardiac arrests, 91/397 (23%) reoperations, 219/2857 (8%) readmissions, and 14/87 (16%) deaths occurred within 2 days of the index surgery. CONCLUSIONS: The perioperative period for patients undergoing MIP and MIpN remains a critical period in which serious adverse events do occur. Same day discharge may be a viable option for select patients, but a period of observation to ensure patients safety should remain the standard of care for most individuals undergoing MIP and MIpN. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e523-e523 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Ginsburg More articles by this author Alberto Andres Castro Bigalli More articles by this author Rosalia Viterbo More articles by this author Richard Greenberg More articles by this author Robert Uzzo More articles by this author David Chen More articles by this author Marc Smaldone More articles by this author Alexander Kutikov More articles by this author Andres Correa More articles by this author Expand All Advertisement Loading ...