Same Day Discharge Versus Overnight Observation Protocols – Similar Outcomes Following Artificial Urinary Sphincter Surgery

Abstract

To analyze our institutional experience transitioning from overnight observation (OBS) to same day surgery (SDS) for artificial urinary sphincter (AUS) procedures. Prior research has questioned the need for OBS following AUS surgery. We retrospectively reviewed AUS surgeries performed by a single surgeon at our tertiary academic medical center between 08/2013 and 01/2020. Patients were grouped based on discharge status: OBS vs SDS. Cost savings associated with SDS were estimated using room and bed charges from a contemporary group of AUS patients. We identified 525 AUS cases that met inclusion criteria. Men in the SDS group (n=318) were more likely to have undergone a virgin AUS insertion and were slightly younger and healthier. Men in the OBS group (n=207) were more likely to suffer an immediate postoperative complication (1% vs 0%, P < .01) and to be readmitted within 90 days of surgery (15% vs 5%, P < .01). The groups did not vary with respect to multiple other perioperative outcomes measures. Among patients who underwent AUS surgery between 09/2017 and 08/2020, those with OBS status (n=39) had mean additional room and bed charges of $ 745 ± 302 vs none for SDS patients (n=183). SDS for AUS insertion is safe, effective, and associated with significant cost savings. Routine overnight observation after AUS insertion appears to be unnecessary.