Higher 30-day Complication Rate Research Articles

Patient Frailty is Correlated With Increased Adverse Events and Costs After Revision Knee Arthroplasty

BackgroundFrailty can predict adverse outcomes after various orthopaedic procedures, but is not well-studied in revision total knee arthroplasty (rTKA). We investigated the correlation between the Hospital Frailty Risk Score (HFRS) and post-rTKA outcomes. MethodsUsing the Nationwide Readmissions Database, we identified rTKA patients discharged from January 2017 to November 2019 for the most common diagnoses (mechanical loosening, infection, and instability). Using HFRS, we compared 30-day readmission rate, length of stay, and hospitalization cost between frail and nonfrail patients with multivariate and binomial regressions. The 30-day complication and reoperation rates were compared using univariate analyses. We identified 25,177 mechanical loosening patients, 12,712 infection patients, and 9,458 instability patients. ResultsFrail patients had higher rates of 30-day readmission (7.8 versus 3.7% for loosening, 13.5 versus 8.1% for infection, 8.7 versus 3.9% for instability; P < .01), longer length of stay (4.1 versus 2.4 days for loosening, 8.1 versus 4.4 days for infection, 4.9 versus 2.4 days for instability; P < .01), and greater cost ($32,082 versus $27,582 for loosening, $32,898 versus $28,115 for infection, $29,790 versus $24,164 for instability; P < .01). Frail loosening patients had higher 30-day complication (6.8 versus 2.9%, P < .01) and reoperation rates (1.8 versus 1.2%, P = .01). Frail infection patients had higher 30-day complication rates (14.0 versus 8.3%, P < .01). Frail instability patients had higher 30-day complication (8.0 versus 3.5%, P < .01) and reoperation rates (3.2 versus 1.6%, P < .01). ConclusionsThe HFRS may identify patients at risk for adverse events and increased costs after rTKA. Further research is needed to determine causation and mitigate complications and costs.

MP56-11 IMPACT OF TYPES OF PREVIOUS ABDOMINAL SURGERY ON PERIOPERATIVE OUTCOMES IN PATIENTS UNDERGOING ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL URINARY DIVERSION

You have accessJournal of UrologyCME1 Apr 2023MP56-11 IMPACT OF TYPES OF PREVIOUS ABDOMINAL SURGERY ON PERIOPERATIVE OUTCOMES IN PATIENTS UNDERGOING ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL URINARY DIVERSION Sij Hemal, Michael Eppler, Jorge Ballon, Gus Miranda, Ryan Davis, Aref Sayegh, Jie Cai, Inderbir Gill, Monish Aron, Mihir Desai, and Giovanni Cacciamani Sij HemalSij Hemal More articles by this author , Michael EpplerMichael Eppler More articles by this author , Jorge BallonJorge Ballon More articles by this author , Gus MirandaGus Miranda More articles by this author , Ryan DavisRyan Davis More articles by this author , Aref SayeghAref Sayegh More articles by this author , Jie CaiJie Cai More articles by this author , Inderbir GillInderbir Gill More articles by this author , Monish AronMonish Aron More articles by this author , Mihir DesaiMihir Desai More articles by this author , and Giovanni CacciamaniGiovanni Cacciamani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with prior lower abdominal/pelvic surgery are likely to have significant post-surgical intra-abdominal adhesions that may distort the anatomy. Such a “hostile” abdomen has been considered a relative contraindication for subsequent complex robotic urologic surgery, such as robotic radical cystectomy with intracorporeal urinary diversion (RRC-ICUD). Herein, we evaluated outcomes of patients undergoing RRC-ICUD with a history of prior lower abdominal/pelvic surgery stratified by type of previous abdominal insult. METHODS: From 07/2010 to 12/2021, 445 consecutive patients underwent RRC-ICUD for bladder cancer. Patients with previous abdominal surgery (PAS) were divided into 4 cohorts by PAS type: within surgical Region of Interest (sROI); pelvic vs abdominal; major vs minor; and approach of PAS [minimally invasive (MIS) vs open]. Outcomes of interest were operative times (OTs), overall 30-day complication rate, readmission rate and genitourinary (GU) complications. Multivariate analyses assessed impact of the type of PAS on the outcomes of interest (p<0.05 significance level). RESULTS: Our cohort included a total of 445 patients: 266 with no PAS and 179 with PAS; 156 (89%) with PAS in sROI vs 19 (11%) with PAS not in sROI; 113 (64%) Major vs 63 (36%) Minor PAS; 82 (47%) with Pelvic PAS vs 93 (53%) with abdominal PAS; 22 (37%) with prior MIS vs 38 (63%) with open PAS. Oncologic outcomes: no significant differences between soft tissue positive margins amongst all 4 cohorts. Multivariate analysis: previous pelvic surgery and type of approach of PAS did not adversely impact perioperative outcomes (all p>0.05). PAS in sROI trended towards a higher overall GU complication rate (RR=3.8, p=0.08). Prior major PAS trended towards a higher 30-day complication rate (RR=1.9, p=0.06) and higher GU complication rate (RR=2.1, p=0.07). Across the models, BMI independently predicted longer OT (p=0.02)(Figure 1). CONCLUSIONS: In experienced hands, RRC-ICUD is feasible in a previously operated abdomen. However, patients with PAS in the sROI or major PAS should be counseled on a higher peri- and post-operative complication rate. Obese patients are likely to have prolonged operative times. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e778 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sij Hemal More articles by this author Michael Eppler More articles by this author Jorge Ballon More articles by this author Gus Miranda More articles by this author Ryan Davis More articles by this author Aref Sayegh More articles by this author Jie Cai More articles by this author Inderbir Gill More articles by this author Monish Aron More articles by this author Mihir Desai More articles by this author Giovanni Cacciamani More articles by this author Expand All Advertisement PDF downloadLoading ...

Racial and Ethnic Disparities in Total Joint Arthroplasty Care: A Contemporary Systematic Review and Meta-Analysis

BackgroundTotal joint arthroplasty (TJA) is one of the most common surgical procedures in the United States; however, racial and ethnic disparities in utilizations and outcomes have been well documented. This systematic review and meta-analysis investigated associations between race/ethnicity and several metrics in total hip arthroplasty (THA) and total knee arthroplasty (TKA). MethodsIn August 2021, PubMed, Scopus, CINAHL, and SPORTDiscus databases were queried. Sixty three studies investigating racial/ethnic disparities in TJA utilizations, complications, mortalities, lengths of stay (LOS), discharge dispositions, readmissions, and reoperations were included. Study quality was assessed using a modified Newcastle-Ottawa Scale. ResultsA majority of studies demonstrated disparities in TJA utilizations and outcomes. Black patients exhibited higher rates of 30-day complications (THA odds ratio [OR] 1.18, 95% confidence interval [CI] 1.08-1.29; TKA OR 1.20, 95% CI 1.10-1.31), 30-day mortality (THA OR 1.27, 95% CI 1.08-1.48), prolonged LOS (THA mean difference [MD] +0.27 days, 95% CI 0.21-0.33; TKA MD +0.30 days, 95% CI 0.20-0.40), nonhome discharges (THA OR 1.47, 95% CI 1.37-1.57; TKA OR 1.65, 95% CI 1.38-1.96), and 30-day readmissions (THA OR 1.13, 95% CI 1.08-1.19; TKA OR 1.19, 95% CI 1.16-1.21) than White patients. Rates of complications (THA 1.18, 95% CI 1.03-1.36), prolonged LOS (TKA MD +0.20 days, 95% CI 0.17-0.23), and nonhome discharges (THA OR 1.26, 95% CI 1.10-1.45; TKA OR 1.37, 95% CI 1.22-1.53) were also increased among Hispanic patients, while Asian patients experienced longer LOS (TKA MD +0.09 days, 95% CI 0.05-0.12) but fewer readmissions. Outcomes among American Indian-Alaska Native and Pacific Islander patients were infrequently reported but similarly inequitable. ConclusionRacial and ethnic disparities in TJA utilizations and outcomes are apparent, with minority patients often demonstrating lower rates of utilizations and worse postoperative outcomes than White patients. Continued research is needed to evaluate the efficacy of recent efforts dedicated to eliminating inequalities in TJA care. Level of EvidenceIV.

Surgical Outcomes in Patients With Preoperative Anemia Undergoing Colectomy for Colon Cancer.

Preoperative anemia is relatively common in colon cancer patients; however, its impact on short-term surgical outcomes is not well established. The aim of our study was to evaluate short-term surgical outcomes in colon cancer patients with preoperative anemia undergoing colectomy. We performed a 4-year analysis of the ACS-NSQIP and included all adult patients who underwent colectomy for colon cancer. Patients were stratified into two groups based on preoperative anemia (Preop Anemia, No Preop Anemia). Our outcome measures were 30-day complications, 30-day unplanned readmissions, and 30-day mortality. A total of 35,243 colon cancer patients who underwent colectomy were included in the analysis, of whom 50.4% had preoperative anemia. The mean age was 65±13years and the mean hemoglobin level was 12±2g/dL. Patients in the anemia group were more likely to be African American, have higher ASA class ≥3, and were more likely to receive at least 1 unit of packed red blood cells preoperatively (7.1% versus 0.3%, P<0.01). Patients in the anemia group had higher rates of 30-day complications (34.5% versus 16.6%, P<0.01), 30-day readmission related to the principal procedure (11.7% versus 8.7%, P<0.01), and 30-day mortality (3.1% versus 1%, P<0.01). On regression analysis, preoperative anemia was independently associated with higher odds of 30-day complications (P<0.01), but not 30-day readmission, or 30-day mortality (P=0.464 and P=0.362 respectively). Preoperative anemia appears to be associated with postoperative complications. Preoperatively optimizing hemoglobin levels may lead to improved outcomes.

Frailty Is Associated With Increased 30-Day Adverse Events and Hospitalization Costs After Primary Total Hip Arthroplasty

BackgroundFrailty can predict adverse outcomes for multiple medical conditions and surgeries but is not well studied in total hip arthroplasty (THA). We evaluate the association between Hospital Frailty Risk Score and postoperative events and costs after primary THA. MethodsUsing the National Readmissions Database, we identified primary THA patients for osteoarthritis, osteonecrosis, or hip fracture from January to November 2017. Using Hospital Frailty Risk Score, we compared 30-day readmission rate, hospital course duration, and costs between frail and nonfrail patients for each diagnosis, controlling for covariates. Thirty-day complication and reoperation rates were compared using univariate analysis. ResultsWe identified 167,700 THAs for osteoarthritis, 5353 for osteonecrosis, and 7246 for hip fractures. Frail patients had increased 30-day readmission rates (5.3% vs 2.5% for osteoarthritis, 7.1% vs 3.3% for osteonecrosis, 8.4% vs 4.3% for fracture; P < .01), longer hospital course (3.4 vs 1.9 days for osteoarthritis, 4.1 vs 2.1 days for osteonecrosis, 6.3 vs 3.9 days for fracture; P < .01), and increased costs ($18,712 vs $16,142 for osteoarthritis, $19,876 vs $16,060 for osteonecrosis, $22,185 vs $19,613 for fracture; P < .01). Frail osteoarthritis patients had higher 30-day complication (4.4% vs 1.9%; P < .01) and reoperation rates (1.6% vs 0.93%; P < .01). Frail osteonecrosis patients had higher 30-day complication rates (5.3% vs 2.6%; P < .01). Frail hip fracture patients had higher 30-day complication (6.6% vs 3.8%; P < .01) and reoperation rates (2.9% vs 1.8%; P < .01). ConclusionFrailty is associated with increased healthcare burden and postoperative events after primary THA. Further research can identify high-risk patients and mitigate complications and costs.

Effect of Daily Dosage of Morphine Milligram Equivalents on Free Flap Complications: A Single-Institution Retrospective Study

There appears to be an association between preoperative opioid use and postoperative complications. We sought to determine whether patients with a history of chronic opiate use (defined as 3 months or more of sustained use) prior to undergoing free flap surgery have higher rates of 30-day complications. A retrospective review of patients undergoing free flaps from 2015 to 2020 was performed. Patient characteristics were analyzed, including daily preoperative dose of opiates, which were then converted to morphine milligram equivalents; intra-operative variables such as estimated blood loss and operating room time; and 30-day outcomes, including wound and flap complications, return to the operating room, and readmissions. One hundred fifty-five patients received 160 free flaps. Of these flaps, 50/160 (31%) were performed on patients with an opiate prescription for at least three months prior to surgery. Using multivariable analysis, morphine milligram equivalents, a surrogate for opioid dose, were significantly associated with flap complications (odds ratio (OR) 1.011, 95% confidence interval (CI) 1.003-1.020, p<0.01), partial flap loss (OR 1.010, 95% CI 1.003-1.019, p<0.01), and surgical site infections (OR 1.017, 95% CI 1.007-1.027, p<0.01). Additionally, estimated blood loss was associated with partial flap loss (OR 4.838, 95% CI 1.589-14.728, p<0.006), and operating room time was also associated with flap complications (OR 1.337, 95% CI 1.152-1.150, p<0.01). Chronic preoperative opioid use is common for free flap surgery, and according to our single-center experience, higher daily doses are a risk factor for flap complications and surgical site infections. These findings add to the growing body of evidence that opioid use is a modifiable risk factor that may increase surgical morbidity.

Intraoperative Ureteral Stent Use at Radical Cystectomy is Associated with Higher 30-Day Complication Rates.

Radical cystectomy/urinary diversion is a high risk procedure. Intraoperative stents are commonly utilized to decrease ureteroenteric anastomosis related complications. Institutionally some surgeons routinely use intraoperative stents while others do not, providing an opportunity to compare complication differences. We queried a prospective database of 283 patients enrolled in a randomized controlled trial evaluating 30-day perioperative complications with goal directed fluid therapy following open radical cystectomy/urinary diversion between 2014 and 2018. Ureteroenteric anastomosis specific complications (ureteral obstruction, urinary leak, urinary infections/sepsis and intra-abdominal abscess) were compared between groups (intraoperative stent vs nonintraoperative stent group) using Fisher exact test and quantified using logistic regression. The nonintraoperative stent group (77 of 283 patients, 27%) was older (median 72 vs 69 years) and was more likely to receive neoadjuvant chemotherapy (53% vs 40%), have baseline renal insufficiency (43% vs 30%) and undergo an ileal conduit (92% vs 53%). However, despite higher comorbidity, the nonintraoperative stent group had a significantly lower rate of ureteroenteric anastomosis complications (14% vs 32%, p=0.004). Since continent diversions may be associated with higher complications, the nonintraoperative stent group with ileal conduit was also compared to intraoperative stent cohorts with ileal conduit, and ureteroenteric anastomosis complications remained lower in the nonintraoperative stent group (14% vs 28%, p=0.043). Multivariable logistic regression showed significantly increased odds of urinary complications with intraoperative stent use (OR 3.55, 95% CI 2.93-4.31; p <0.0001). Importantly there was no obstruction and only 1 leak (1.3%) in the nonintraoperative stent group. Contrary to conventional belief, we found intraoperative stent use in radical cystectomy/urinary diversion was associated with significantly higher infectious complications and urgent care visits, and significantly increased the odds of 30-day ureteroenteric anastomosis associated complications.

Clinical Impact of Antecedent Bariatric Surgery on Liver Transplant Outcomes: A Retrospective Matched Case-control Study.

Bariatric surgery (BS) may be associated with significant malabsorption and nutritional deficiencies. Between March 1987 and January 2017, we performed 922 liver transplants (LT) at our institution; 33 had antecedent BS. We matched the BS cohort to LT recipients without BS (1:3 matching) based on exact matching for gender and cancer and inverse variance matching for age, LT body mass index, MELD score, and transplant date. We analyzed outcomes in 132 LT recipients (33 BS; 99 non-BS). The BS cohort comprised 26 (79%) women with a mean age of 52.4 years. The BS procedures included 20 Roux-en-Y gastric bypass (61%), 6 jejunoileal bypass (18%), 3 gastric band (9%), 2 sleeve gastrectomy (6%), and 1 duodenal switch (3%). The primary indications for LT listing were alcoholic cirrhosis (9; 27%), nonalcoholic steatohepatitis (7; 21%), hepatitis C (8; 24%), and hepatocellular carcinoma (3; 9%). At LT, body mass index for the BS cohort was 29.6, and MELD was 24. Compared with matched controls, BS recipients did not have longer LT length of hospital stay (17.8 versus 15.7 d, P = 0.71), longer intensive care unit length of stay (5.3 versus 4.1 d, P = 0.16), or higher 30-day complication rate (76% versus 85%, P = 0.43). Overall patient survival was similar (1- and 3-y survival was 90.1% and 75.9% for BS; 90.9% and 76.4% for non-BS, P = 0.34). A history of BS does not portend a deleterious effect on LT outcomes.

Association of Race With Bariatric Surgery Outcomes

The outcomes of bariatric surgery vary considerably across patients, but the association of race with these measures remains unclear. To examine the association of race on perioperative and 1-year outcomes of bariatric surgery. Propensity score matching was used to assemble cohorts of black and white patients from the Michigan Bariatric Surgery Collaborative who underwent a primary bariatric operation (Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding) between June 2006 and January 2017. Cohorts were balanced on baseline characteristics and procedure. Conditional fixed-effects models were used to evaluate the association of race on outcomes within hospitals and surgeons. Data analysis occurred from June 2006 through August 2018. Thirty-day complications and health care resource utilization measures, as well as 1-year weight loss, comorbidity remission, quality of life, and satisfaction. In each group, 7105 patients were included. Black patients had a higher rate of any complication (628 [8.8%] vs 481 [6.8%]; adjusted odds ratio, 1.33 [95% CI, 1.17-1.51]; P = .02), but there were no significant differences in the rates of serious complications (178 [2.5%] vs 135 [1.9%]; adjusted odds ratio, 1.32 [95% CI, 1.05-1.66]; P = .29) or mortality (5 [0.10%] vs 7 [0.10%]; adjusted odds ratio, 0.73 [95% CI, 0.23-2.31]; P = .54). Black patients had a greater length of stay (mean [SD], 2.2 [3.0] days vs 1.9 [1.7] days; adjusted odds ratio, 0.30 [95% CI, 0.20-0.40]; P < .001), as well as a higher rate of emergency department visits (541 [11.6%] vs 826 [7.6%]; adjusted odds ratio, 1.60 [95% CI, 1.43-1.79]; P < .001) and readmissions (414 [5.8%] vs 245 [3.5%]; adjusted odds ratio, 1.73 [95% CI, 1.47-2.03]; P < .001). At 1 year, black patients had lower mean total body weight loss and as a percentage of weight (32.0 kg [26%]; vs 38.3 kg [29%]; P < .001) and this held true across procedures. Remission of hypertension was lower for black patients (564 [40.0%] vs 1096 [56.0%]; P < .001), but the rate of sleep apnea remission (467 [62.6%] vs 615 [56.1%]; P = .005) and gastroesophageal reflux disease (309 [78.6%] vs 453 [75.4%]; P = .049) were higher. There were no significant differences in remission of diabetes with insulin dependence, diabetes without insulin dependence,or hyperlipidemia hyperlipidemia. Fewer black patients than white patients reported a good or very good quality of life (1379 [87.2%] vs 2133 [90.4%]; P = .002) and being very satisfied with surgery (1908 [78.4%] vs 2895 [84.2%]; P < .001) at 1 year. Black patients undergoing bariatric surgery in Michigan had significantly higher rates of 30-day complications and resource utilization and experienced lower weight loss at 1 year than a matched cohort of white patients. While sleep apnea and gastroesophageal reflux disease remission were higher and hypertension remission lower in black patients, comorbidity remission was otherwise similar between matched cohorts. Racial and cultural differences among patients should be considered when designing strategies to optimize outcomes with bariatric surgery.

Impact of frailty on complications in patients with thoracic and thoracolumbar spinal fracture

ObjectivesIt is well-documented that geriatric patients are at risk for serious injuries after fracture due to pre-existing medical conditions, physical changes of aging, and medication effects. Frailty has been demonstrated to be a predictor of morbidity and mortality in inpatient head and neck surgery, and for surgical intervention for adult spinal deformity and degenerative spine disease. However, the impact of frailty on complications following thoracolumbar/thoracic fractures are unknown and has not been previously assessed in the literature, particularly in a nationwide setting. Patients and MethodsThis was a retrospective study of the prospectively-collected American College of Surgeons National Surgical Quality Improvement database for the years 2007 through 2012. Patients who underwent spinal decompression (+/− fusion) or an alternative intervention, defined as vertebroplasty or kyphoplasty (VP/KP) for thoracic or thoracolumbar fracture were identified. Frailty status was determined using a modified frailty index from the Canadian Study of Health and Aging Frailty Index, with frailty defined as a score = 0.27. 30-day morbidity and mortality were compared between frail and non-frail patients in each treatment group. ResultsA total of 303 patients were included in this study. Of these, 38% of patients had VP/KP and 62% underwent surgery. Within the VP/KP cohort, 26% were frail. The proportion of these patients who developed at least one complication was 3.3% versus 3.6% for non-frail patients (p = 1.0). The 30-day mortality for frail versus not frail patients in this cohort was 0% versus 2.4% (p = 1.0). Among the surgical group, 13% were frail. In contrast, the likelihood of complications was 33.3% among frail patients and 4.2% for non-frail patients (p < 0.001). Frail patients also had a 16.7% 30-day mortality rate as compared to 0.6% in the non-frail group (p = 0.001). When comparing the frail versus non-frail patients overall, frail patients had a complication rate of 16.7%, as opposed to 4.0% in non-frail patients. ConclusionFrailty and surgical intervention are correlated with a higher 30-day complication rate in patients with thoracic and thoracolumbar fracture. This finding is an important consideration for surgical decision-making and patient counseling on treatment options.

The association of age with perioperative morbidity and mortality among men undergoing radical prostatectomy

IntroductionOlder age is considered a relative contraindication to radical prostatectomy (RP). However, data are limited regarding the impact of age on perioperative outcomes following RP. We examined the association of age with perioperative outcomes following RP to inform risk-stratification and management. Materials and methodsWe identified 35,968 men aged 18 to 89 years who underwent RP from 2010 to 2015 in the National Surgical Quality Improvement Program (NSQIP) database. The associations of age with 30-day complications and perioperative morbidity were evaluated using logistic regression, adjusted for patient features. Age was modeled both as a categorical and nonlinear continuous variable. ResultsMedian age at surgery was 63 years (IQR: 58–67). Increasing age was associated with greater rates of perioperative morbidity. Compared to men aged<60 years, men aged 70 to 89 years had statistically significantly higher rates of 30-day complications (6.4% vs. 4.4%, P<0.0001), perioperative blood transfusion (6.0% vs. 3.7%, P<0.0001), readmission (4.9% vs. 3.9%, P<0001), and 30-day mortality (0.3% vs. 0.1%, P<0.0001). In multivariable analyses, older age was independently associated with increased risks of perioperative morbidity. Moreover, there was a nonlinear relationship of age with perioperative morbidity, wherein rates of 30-day complications, perioperative blood transfusion, and readmission increased after approximately 70 years of age. ConclusionsIn this national cohort, we observed a nonlinear association of age with perioperative morbidity, with increasing rates of 30-day complications, perioperative blood transfusion, and readmission after approximately 70 years of age. These results have implications for risk-stratification, patient counseling, and treatment selection among older men.

Contemporary comparison of aortofemoral bypass to alternative inflow procedures in the Veteran population

ObjectiveMultiple vascular inflow reconstruction options exist for claudication, including aortofemoral bypass (AFB) and alternative inflow procedures (AIPs) such as femoral reconstruction with iliac stents, and femoral-femoral, iliofemoral, and axillofemoral bypass. Contemporary multi-institution comparison of these techniques is lacking. MethodsThe Veterans Affairs Surgical Quality Improvement Project (VASQIP) national database (2005-2013) was used to compare AFB vs AIP in a propensity-matched analysis. Primary outcome was mortality at 30 and 90 days. Secondary outcomes included rates of postoperative complications. Multivariable regression assessed the adjusted effect of inflow procedure type on mortality. ResultsA matched cohort of 748 claudicant patients (373 AFB, 375 AIP) was identified. The AFB and AIP groups had similar mean age (59.9 vs 60.8 years; P = .30), gender (P = .51), race (P = .52), recent smoking (79.1% vs 76.5%; P = .43), history of coronary artery disease (14.8% vs 14.7%; P > .99), chronic obstructive pulmonary disease (18.8% vs 18.4%; P = .92), renal insufficiency (5.9% vs 6.1%; P > .99), and diabetes (22% vs 20%; P = .53), and American Society of Anesthesiologists Physical Status Classification (P = .41). The AFB group had longer mean operative time (4.9 vs 3.5 hours; P < .0001), more senior resident assistants (72.4% vs 61.1%; P < .0001), and greater mean red blood cell transfusion (1.1 vs 0.12 units; P < .0001). AFB and AIP had similar rates of outflow bypass (1.9% vs 1.3%; P = .58) and outflow endovascular interventions (0.54% vs 1.6%; P = .29). AFB trended toward a higher rate of mortality at 30 days postoperatively (2.7% vs 0.8%; P = .06), but by 90 days, the crude mortality rates were similar for the two (2.9% vs 2.1%; P = .5). AFB had higher rates of pneumonia (5.9% vs 0.8%; P < .001), deep vein thrombosis/pulmonary embolism (1.3% vs 0%; P = .03), postoperative transfusion (2.7% vs 0.53%; P = .02), and urinary tract infection (3.5% vs 0.8%; P = .01), but similar rates of myocardial infarction (1.6% vs 0.8%; P = .34), stroke (0.8% vs 0%; P = .12), wound complications (13.1% vs 12.8%; P = .91), renal failure (1.1% vs 0.3%; P = .22), graft failure (1.3% vs 1.1%; P = .75), and return to the operating room (12.9% vs 9.6%; P = .17). Multivariable analysis showed AFB was not independently associated with mortality (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.1-3.0). Significant factors included age (OR, 1.2; 95% CI, 1.1-1.4), postoperative renal insufficiency (OR, 2.5; 95% CI, 1.6-4.0), and unplanned reintubation (OR, 35.5; 95% CI, 3.1-399). ConclusionsFor claudicant patients with inflow disease, AFB has higher rates of 30-day complications and a trend toward higher mortality; however by 90 days postoperatively, the two procedure types have similar rates of mortality.

MP6-11 PREDICTORS OF READMISSION FOLLOWING OUTPATIENT UROLOGICAL SURGERY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2014MP6-11 PREDICTORS OF READMISSION FOLLOWING OUTPATIENT UROLOGICAL SURGERY Aksharananda Rambachan, Richard S. Matulewicz, Matthew Pilecki, John YS. Kim, and Shilajit Kundu Aksharananda RambachanAksharananda Rambachan More articles by this author , Richard S. MatulewiczRichard S. Matulewicz More articles by this author , Matthew PileckiMatthew Pilecki More articles by this author , John YS. KimJohn YS. Kim More articles by this author , and Shilajit KunduShilajit Kundu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.245AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Patient Protection and Affordable Care Act increases oversight of surgical outcomes and ties readmissions to Medicare reimbursement. Given the increasing volume of outpatient urological procedures, we provide the first multi-institutional, multivariate analysis of the patient factors that contribute to readmission. METHODS Using the National Surgical Quality Improvement Program database from 2011, 7,795 patients were isolated. Multiple logistic regression was utilized to predict 30 day unplanned readmissions controlling for demographics, clinical characteristics and comorbidities. The readmission rates for the 5 most common procedures were calculated along with postoperative complications associated with readmission. RESULTS Outpatient urological surgery had an overall 3.7% readmission rate. The five most common procedures and their readmission rates were cystourethroscopy and resection of bladder tumor (4.97%), laser prostatectomy (4.27%), TURP (4.24%), excision of hydrocele (1.92%) and sling operation for urinary incontinence (0.85%). The most common comorbidities in the readmitted patients included hypertension, diabetes and smoking. Risk adjusted multiple regression indicated that cancer history (OR 3.48), bleeding disorder (OR 2.03), male gender (OR 1.38), ASA level 3 or 4 (OR 1.34) and age (OR 1.01) were significant predictors for readmission. Readmitted patients also had higher rates of 30-day complications. CONCLUSIONS Readmission after outpatient urological surgery occurs at a rate of 3.7%. A history of cancer, bleeding disorder, male gender, ASA level 3 or 4 and age were associated with readmission along with greater rates of medical and surgical complications. Our results may help guide risk reduction initiatives and prevent costly readmissions. Table 1. Predictors of readmission from regression analysis Factor OR p-value 95% C.I. Alcohol use 1.860 .056 .984 3.514 History of COPD 1.323 .197 .865 2.023 Previous percutaneous coronary intervention 1.218 .395 .773 1.917 Previous percutaneous coronary surgery 1.164 .538 .718 1.886 Hypertension .850 .236 .650 1.112 Disseminated Cancer∗ 3.484 .000 1.893 6.410 Steroid Use 1.700 .074 .951 3.042 Bleeding Disorder∗ 2.034 .006 1.227 3.373 Diabetes 1.328 .053 .996 1.771 Dyspnea 1.295 .201 .871 1.926 ASA Level 3 or 4∗ 1.335 .046 1.005 1.774 Function Status prior to Surgery 1.610 .128 .872 2.972 Male gender∗ 1.384 .038 1.018 1.882 Age (year)∗ 1.016 .001 1.006 1.026 ∗ p<.05 considered to be significant. Model: forced entry (one step), C-stat: .656 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e60-e61 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Aksharananda Rambachan More articles by this author Richard S. Matulewicz More articles by this author Matthew Pilecki More articles by this author John YS. Kim More articles by this author Shilajit Kundu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...