Inpatient Urological Surgery Research Articles

The Mobile Patient Information Assistant (PIA) App during the Inpatient Surgical Hospital Stay: Evaluation of Usability and Patient Approval.

Mobile eHealth apps are becoming increasingly important tools in healthcare management, capable of providing education and support at any time. There is little knowledge about surgical patients' appreciation and use of these apps. The objective of this study was to develop and evaluate a user-friendly medical app (PIA; Patient Information Assistant) for providing individual patient information before and after inpatient urological surgery. Twenty-two patients aged 35 to 75 years were provided with timely information, push notifications, and personalized agendas (e.g., date of presentation, time of surgery, time of doctor's consultation, imaging appointment) via the PIA app. Of the 22 patients, 19 evaluated the PIA app in terms of usage and usability, benefits, and potential for improvement. Of the study participants, 95% did not need any assistance to use the app, 74% confirmed that the PIA app made them feel better informed and more satisfied with their hospital stay, and 89% stated that they would like to re-use the PIA app and support the general use of medical apps in healthcare. Thus, we created an innovative digital health information tool, allowing targeted support for doctor-nurse-patient communication and offering great potential for patient support before and after surgery. Our study revealed that use of an app during the surgical hospital stay is readily accepted and benefits patients by acting as an additional informative tool.

Trends in outpatient versus inpatient urologic surgery at a university academic medical center.

To analyze trends in outpatient and inpatient urologic surgeries at a large university academic medical center and test the hypothesis that the proportion of outpatient surgeries has been increasing as compared to inpatient surgeries in urology. We analyzed a total of 33,054 claims for urologic surgeries at a large university academic medical center from 2010 to 2020, of which 23.2% met inpatient criteria (n = 7695), whereas 76.7% were outpatient (n = 25,359). Although outpatient claims increased yearly by an average of 24%, inpatient claims increased yearly by an average of only 1%. Over the same period, Medicare-specific outpatient claims mirrored these trends, and Medicare-specific inpatient claims decreased. Outcomes of inpatient surgeries are used as a metric for quality by the Centers for Medicare and Medicaid Services (CMS) as well as US News and World Report (USNWR) rankings. However, with increasing numbers of minimally invasive operations, a large proportion of urologic surgeries are performed on an outpatient basis. As this trend continues, it will be important for organizations like CMS and USNWR to incorporate methods of measuring quality that better reflect outpatient surgical outcomes for the urologic subspecialty.

Association between race and in-hospital outcomes in children with spina bifida following inpatient urologic surgery.

Post-operative complication rates may vary among racial and/or ethnic groups and have not been previously described in individuals with spina bifida (SB) undergoing urologic surgery. The aim of this study was to compare in-hospital complication frequencies of individuals with SB following urologic surgery by race/ethnicity. The Nationwide Inpatient Sample was used to identify pediatric patients with SB who underwent inpatient urologic procedures. A pediatric cohort (<18 years old) with SB that underwent urologic surgery were assessed. All analyses report weighted descriptive statistics, outcomes, and race/ethnicity was the primary predictor variable. The primary outcome of interest was post-operative complications which were defined using NSQIP ICD-9 code definitions. Secondary analysis included length of stay (LOS), and encounter cost was estimated using the cost-to-charge ratio files provided by the Healthcare Cost and Utilization Project. The unadjusted model showed no differences in complications, LOS, and cost. In the adjusted model there were no differences in complications, LOS, and cost between Black and White encounters. However, Hispanic ethnicity was associated with a 20%(95%CI: 4-40%) increase in LOS and 18%(95%CI: 2-35%, p = 0.02) increase in cost compared to White encounters. There was no evidence of variation for in-hospital complication rates among racial/ethnic groups undergoing urologic surgery. Hispanic ethnicity was associated with higher costs and longer LOS in pediatric SB encounters.

Analysis of National Trends in Hospital Acquired Conditions Following Major Urologic Surgery Before and After Implementation of the Hospital Acquired Condition Reduction Program

To define the rates of common hospital acquired conditions (HACs) in patients undergoing major urologic surgery over a period of time encompassing the implementation of the Hospital Acquired Condition Reduction program, and to evaluate whether implementation of the HAC reimbursement penalties in 2008 was associated with a change in the rate of HACs. Using American College of Surgeons National Surgical Quality Improvement Program data, we determined rates of HACs in patients undergoing major inpatient urologic surgery from 2005 to 2012. Rates were stratified by procedure type and approach (open vs laparoscopic and/or robotic). Multivariable logistic regression was used to determine the association between year of surgery and HACs. We identified 39,257 patients undergoing major urologic surgery, of whom 2300 (5.9%) had at least one hospital acquired condition. Urinary tract infection (2.6%) was the most common, followed by surgical site infection (2.5%) and venous thrombotic events (0.7%). Multivariable logistic regression analysis demonstrated that open surgical approach, diabetes, congestive heart failure, chronic obstructive pulmonary disease, weight loss, and American Society of Anesthesiology class were among the variables associated with higher likelihood of HAC. We observed a nonsignificant secular trend of decreasing rates of HAC from 7.4% to 5.8% HACs during the study period, which encompassed the implementation of the Hospital Acquired Condition Reduction program. HACs occurred at a rate of 5.9% after major urologic surgery, and are significantly affected by procedure type and patient health status. The rate of HAC appeared unaffected by National Reduction program in this cohort. Better understanding of the factors associated with HACs is critical in developing effective reduction programs.

Mortality and Functional Outcomes After Minor Urological Surgery in Nursing Home Residents: A National Study.

To determine outcomes of minor urological surgery in frail older adults. Retrospective cohort study. U.S. nursing homes (NHs). NH residents aged 65 and older undergoing minor inpatient urological surgery (cystoscopy, bladder biopsy, transurethral resection of bladder tumor, prostate biopsy, transurethral resection of prostate, removal of ureteral obstruction, suprapubic tube placement) in the United States between 2004 and 2012 (N=34,605). One-year mortality and changes in functional status before and after surgery using the Minimum Data Set Activity of Daily Living (MDS-ADL) summary scale. Overall 1-year mortality was 50%, and on average, residents had a 1.9-point worsening in their MDS-ADL score at 1 year, whereas the most highly functional residents (baseline quartile of MDS-ADL scores (0-12)) had a 4.7-point worsening in their MDS-ADL scores at 1 year. Functional decline in residents 1 year after surgery was associated with decline in function in the 6 months before surgery (adjusted hazard ratio (aH)=2.39, 95% confidence interval (CI)=2.29-2.49), emergency procedures (aHR=1.37, 95% CI=1.31-1.43), older age (≥85 vs 65-74, aHR=1.17, 95% CI=1.11-1.23), and baseline cognitive impairment (aHR=1.15, 95% CI=1.11-1.20). Despite the low complexity of minor urological procedures, NH residents experience high mortality and many demonstrate sustained functional decline up to 1-year postoperatively.

Evaluation of Unplanned Hospital Readmissions After Major Urologic Inpatient Surgery in the Era of Accountable Care

To provide a multi-institutional analysis of clinical factors predicting unplanned hospital readmission after major inpatient urologic surgery. The American College of Surgeons National Surgical Quality Improvement Program is a risk-adjusted data collection mechanism for analyzing clinical outcomes data including 30-day perioperative readmissions and complications. We identified 23,108 patients who underwent major inpatient urologic surgery from 2011 to 2012. Readmission rates were determined and stratified by procedure type. Multiple logistic regression was used to determine independent risk factors for 30-day unplanned hospital readmissions. Of a total of 23,108 patients undergoing urologic surgery, 1329 patients (5.8%) had unplanned readmissions. Upper tract reconstruction and urinary diversion without cystectomy (21/102) and with cystectomy (291/1662) had the highest rates of readmission of all procedures analyzed. Readmitted patients had a 64.2% (853/1329) and 64.4% (855/1329) rate of major and minor complications, respectively, compared with 6.7% (1459/21,779) and 15.9% (3462/21,779) for patients not readmitted (P <.02). Organ space infection (odds ratio [OR] 15.23), pulmonary embolism (OR 12.14), deep venous thrombosis (OR 10.96), and return to the operating room (OR 8.46) were the most substantial predictors of readmission. Laparoscopic-robotic procedures had significantly lower readmission rates compared with open procedures for prostatectomy, partial nephrectomy, and nephrectomy (P <.01). Readmission after inpatient urologic surgery occurs at a rate of 5.8%, with cystectomy and urinary diversion demonstrating the highest rates. Major and minor postoperative complications were the most substantial predictors of readmission. These results may guide risk reduction initiatives to prevent readmissions after major urologic surgery.

MP96-14 ANALYSIS OF NATIONAL TRENDS IN HOSPITAL ACQUIRED CONDITIONS FOLLOWING MAJOR UROLOGIC SURGERY BEFORE AND AFTER IMPLEMENTATION OF THE HOSPITAL ACQUIRED CONDITION REDUCTION PROGRAM

Objective To define the rates of common hospital acquired conditions (HACs) in patients undergoing major urologic surgery over a period of time encompassing the implementation of the Hospital Acquired Condition Reduction program, and to evaluate whether implementation of the HAC reimbursement penalties in 2008 was associated with a change in the rate of HACs. Methods Using American College of Surgeons National Surgical Quality Improvement Program data, we determined rates of HACs in patients undergoing major inpatient urologic surgery from 2005 to 2012. Rates were stratified by procedure type and approach (open vs laparoscopic and/or robotic). Multivariable logistic regression was used to determine the association between year of surgery and HACs. Results We identified 39,257 patients undergoing major urologic surgery, of whom 2300 (5.9%) had at least one hospital acquired condition. Urinary tract infection (2.6%) was the most common, followed by surgical site infection (2.5%) and venous thrombotic events (0.7%). Multivariable logistic regression analysis demonstrated that open surgical approach, diabetes, congestive heart failure, chronic obstructive pulmonary disease, weight loss, and American Society of Anesthesiology class were among the variables associated with higher likelihood of HAC. We observed a nonsignificant secular trend of decreasing rates of HAC from 7.4% to 5.8% HACs during the study period, which encompassed the implementation of the Hospital Acquired Condition Reduction program. Conclusion HACs occurred at a rate of 5.9% after major urologic surgery, and are significantly affected by procedure type and patient health status. The rate of HAC appeared unaffected by National Reduction program in this cohort. Better understanding of the factors associated with HACs is critical in developing effective reduction programs.

Trends in Inpatient Urological Surgery Practice Patterns

IntroductionAs the nation’s population ages and the number of practicing urologists per capita decreases, characterization of practice patterns is essential to understand the current state of the urological workforce and anticipate future needs. Accordingly, we examined trends in adult inpatient urological surgery practice patterns during a 5-year period. MethodsWe used the Nationwide Inpatient Sample data from 2005 through 2009 to identify surgeons and urological surgeries. We classified the urological surgeries into 1 of 7 clinical domains (endourology and stone disease, incontinence, urogenital reconstruction, urologic oncology, benign prostate, renal transplant, and other urological procedures). For each urological surgeon 3 parameters were determined for each year, including 1) case diversity (the number of distinct urological clinical domains in which he/she performed 2 or more procedures per year), 2) subspecialty (the predominant clinical domain of cases that each surgeon performed) and 3) subspecialty focus (the proportion of a surgeon’s total urological cases per year that belonged to his/her assigned clinical domain). We examined trends in these metrics during a 5-year period and compared results between urban and rural practice settings. ResultsWe analyzed data for 2,237 individual surgeons performing 144,138 inpatient surgeries. Urologists’ practice patterns evolved with time toward less case diversity (p <0.001) and greater subspecialty focus (p <0.001). These trends were more pronounced for surgeons practicing in urban vs rural settings (p <0.05). ConclusionsAt a national level urologists’ inpatient surgical practice patterns are narrowing, with less case diversity and greater subspecialty focus. These trends are even more prominent among urologists in urban compared with rural practice settings.

PD02-12 EVALUATION OF UNPLANNED HOSPITAL READMISSIONS AFTER MAJOR UROLOGIC INPATIENT SURGERY IN THE ERA OF ACCOUNTABLE CARE

Objective To provide a multi-institutional analysis of clinical factors predicting unplanned hospital readmission after major inpatient urologic surgery. Materials and methods The American College of Surgeons National Surgical Quality Improvement Program is a risk-adjusted data collection mechanism for analyzing clinical outcomes data including 30-day perioperative readmissions and complications. We identified 23,108 patients who underwent major inpatient urologic surgery from 2011 to 2012. Readmission rates were determined and stratified by procedure type. Multiple logistic regression was used to determine independent risk factors for 30-day unplanned hospital readmissions. Results Of a total of 23,108 patients undergoing urologic surgery, 1329 patients (5.8%) had unplanned readmissions. Upper tract reconstruction and urinary diversion without cystectomy (21/102) and with cystectomy (291/1662) had the highest rates of readmission of all procedures analyzed. Readmitted patients had a 64.2% (853/1329) and 64.4% (855/1329) rate of major and minor complications, respectively, compared with 6.7% (1459/21,779) and 15.9% (3462/21,779) for patients not readmitted ( P P Conclusion Readmission after inpatient urologic surgery occurs at a rate of 5.8%, with cystectomy and urinary diversion demonstrating the highest rates. Major and minor postoperative complications were the most substantial predictors of readmission. These results may guide risk reduction initiatives to prevent readmissions after major urologic surgery.

Hospital-level Variation in the Quality of Benign Inpatient Urologic Surgery

To examine hospital-level variation in outcomes following benign urologic surgeries given that hospital-level variation in surgical outcomes can portend quality and appropriateness of care concerns and identify quality improvement opportunities in perioperative care. Using the Washington State Comprehensive Hospital Abstract Reporting System, we identified patients who underwent transurethral resection of the prostate (TURP), percutaneous nephrostolithotomy (PCNL), and pyeloplasty from 2003 to 2008. We classified prolonged postoperative length of stay (LOS) as that exceeding the 75th percentile, and we measured the rate of Agency for Healthcare Quality Patient Safety Indicators, readmissions, and death. We calculated hospital-specific observed-to-expected event rates using random effects multilevel multivariable models adjusted for age and comorbidity. We identified 6699 TURP patients at 54 hospitals, 2541 PCNL patients at 45 hospitals, and 584 pyeloplasty patients at 36 hospitals. Complication rates were highest after PCNL (22.9% prolonged LOS vs 17.3% for TURP and 13.9% for pyeloplasty, P < .001; 3.4% 90-day mortality vs 0.6% for TURP and 0% for pyeloplasty). Hospital-level variation was most substantial for LOS after TURP and pyeloplasty (8.1% and 14.3% of variance in prolonged LOS, respectively). Hospital-level variation is common after benign inpatient urologic surgeries and may relate to difference in perioperative provider practice patterns. The morbidity of PCNL in this study was higher than expected and merits further investigation.

Utilization and Outcomes of Inpatient Urological Care at Safety Net Hospitals

Because proposed funding cuts in the Patient Protection and Affordable Care Act may impact care for urological patients at safety net hospitals, we examined the use, outcomes and costs of inpatient urological surgery at safety net vs nonsafety net facilities prior to health care reform. Using the Nationwide Inpatient Sample we performed a retrospective cohort study of patients who underwent inpatient urological surgeries from 2007 through 2011. We defined the safety net burden of each hospital based on the proportion of Medicaid and self-pay discharges. We examined the distribution of urological procedures performed and compared in-hospital mortality, prolonged length of stay and costs in the highest quartile of burden (safety net) vs the lowest quartile (nonsafety net). The distribution of urological procedures differed by safety net status with less benign prostate surgery (9.1% safety net vs 11.4% nonsafety net) and major cancer surgery (26.9% vs 34.3%), and more reconstructive surgery (8.1% vs 5.5%) at safety net facilities (p <0.001). Higher mortality at safety net hospitals was seen for nephrectomy (OR 1.68, 95% CI 1.15-2.45) and transurethral resection of the prostate (OR 2.17, 95% CI 1.22-3.87). Patients in safety net hospitals demonstrated greater prolonged length of stay after endoscopic stone surgery (OR 1.20, 95% CI 1.01-1.41). Costs were similar across procedures except for radical prostatectomy and cystectomy. For these procedures the average admission was more expensive at nonsafety net facilities (prostatectomy $11,457 vs $9,610 and cystectomy $27,875 vs $24,048, each p <0.02). Reductions in funding to safety net hospitals with health care reform could adversely impact access to care for patients with a broad range of urological conditions, potentially exacerbating existing disparities for vulnerable populations served by these facilities.

MP9-18 ANTICIPATING THE IMPACT OF ACCOUNTABLE CARE ORGANIZATIONS ON THE COST AND QUALITY OF UROLOGIC CANCER CARE

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 2015MP9-18 ANTICIPATING THE IMPACT OF ACCOUNTABLE CARE ORGANIZATIONS ON THE COST AND QUALITY OF UROLOGIC CANCER CARE Lindsey Herrel, Scott Hawken, Chandy Ellimoottil, Zachary Montgomery, Zaojun Ye, and David Miller Lindsey HerrelLindsey Herrel More articles by this author , Scott HawkenScott Hawken More articles by this author , Chandy EllimoottilChandy Ellimoottil More articles by this author , Zachary MontgomeryZachary Montgomery More articles by this author , Zaojun YeZaojun Ye More articles by this author , and David MillerDavid Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.378AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many believe that Accountable Care Organizations (ACOs) will lead to higher quality and lower cost healthcare, including for specialty care like urology. In this context, we examined baseline outcomes and costs of inpatient urologic cancer surgery at hospitals that joined Medicare ACO programs compared with similar hospitals that are not participating. METHODS We used the Nationwide Inpatient Sample and American Hospital Association Survey to conduct a retrospective cohort study of patients undergoing inpatient urologic cancer surgery at ACO participating hospitals and non-ACO participating hospitals from 2007 through 2011. Hospitals participating in an ACO were identified from the Center for Medicare and Medicaid Services website as of February 2014. Propensity matching based on hospital structural characteristics was performed to identify non-participating hospitals from states with <6% of lives covered in an ACO. For three urologic cancer operations (prostatectomy, nephrectomy, cystectomy) we fit multivariable models to compare in-hospital mortality, prolonged length of stay (LOS, >90th percentile), and total hospital costs for patients treated at ACO and non-ACO participating hospitals. RESULTS Propensity matching identified 352 non-ACO hospitals to compare with 176 ACO participating hospitals. In multivariable analyses, neither mortality nor prolonged LOS differed according to ACO participation. Total hospitals costs were also similar for patients undergoing prostatectomy, nephrectomy and cystectomy at ACO participant versus non-participant hospitals (Figure). CONCLUSIONS Prior to implementation of Accountable Care Organizations, hospitals that now participate in these programs had similar rates of in-hospital mortality, prolonged LOS, and cost for inpatient urologic cancer care compared with hospitals that are not participating. Future studies will determine whether ACO participation meets the high expectations for higher quality and lower cost care in urology and other specialities. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e108-e109 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lindsey Herrel More articles by this author Scott Hawken More articles by this author Chandy Ellimoottil More articles by this author Zachary Montgomery More articles by this author Zaojun Ye More articles by this author David Miller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD2-12 TREATMENT OF PRIAPISM IN THE EMERGENCY DEPARTMENT PRIOR TO UROLOGIC SURGERY CONSULTATION: A CONTEMPORARY EXPERIENCE AT A SINGLE INSTITUTION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Penis/Testis/Urethra: Benign Disease1 Apr 2015PD2-12 TREATMENT OF PRIAPISM IN THE EMERGENCY DEPARTMENT PRIOR TO UROLOGIC SURGERY CONSULTATION: A CONTEMPORARY EXPERIENCE AT A SINGLE INSTITUTION Elizabeth Green, Stephen Kappa, Shreyas Joshi, Melissa Kaufman, and Doug Milam Elizabeth GreenElizabeth Green More articles by this author , Stephen KappaStephen Kappa More articles by this author , Shreyas JoshiShreyas Joshi More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , and Doug MilamDoug Milam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.195AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To review the medical management of priapism patients by the Emergency Department (ED) prior to Urologic Surgery consultation in a contemporary cohort of patients. METHODS Retrospective review of consecutive priapism cases at a single institution from March 2004 to June 2014 was performed utilizing an inpatient Urologic Surgery consultation database. Treatments administered in the ED were gathered from a review of treatment orders. Patients were determined to have been treated successfully prior to Urologic Surgery consultation if they experienced detumescence without Urologic intervention. RESULTS Of the 102 cases of priapism treated at our center, 52 patients (50.9%) were treated with oral or IV medications ordered in the ED. Thirty-nine cases (38.2%) were treated with terbutaline, of which 26 received the medication subcutaneously (median dose 0.25mg) and 14 received the medication administered orally (median dose 10mg). Twenty-one patients (20.5%) were treated with oral pseudoephedrine (median dose 60mg), 9 (8.8%) received diphenhydramine, 6 (5.9%) were treated with topical nitroglycerin paste applied to the penis, and 3 (2.9%) patients were treated with IV sodium bicarbonate. Of the 52 cases treated with medication in the ED, 8 cases (7.8% of all cases, 15.8% of cases treated medically in the ED) experienced detumescence without further intervention. All 8 of these patients received terbutaline (5 patients received median dose 0.5mg subcutaneously, 4 patients received median 10mg po, 1 patient received both). Five of these patients received a median dose of 90mg pseudoephedrine, 3 received topical nitroglycerin paste, and 1 received IV sodium bicarbonate. Of the 8 successfully treated cases, 5 resulted from sickle cell disease, 1 from a psychotropic medication, 1 from cocaine, and 1 case was defined as idiopathic. CONCLUSIONS In this contemporary case series of patients treated for priapism, half of all patients received medications in the ED intended to treat their priapism, of which 15.8% experienced detumescence without further intervention. All patients treated successfully with medications alone received terbutaline, with additional medications including pseudoephedrine, topical nitroglycerin paste, and sodium bicarbonate. To our surprise, almost 20% of patients were initially treated in our own ED with medications judged ineffective by the AUA guidelines. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e44 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Green More articles by this author Stephen Kappa More articles by this author Shreyas Joshi More articles by this author Melissa Kaufman More articles by this author Doug Milam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD2-07 FUNCTIONAL OUTCOMES AND FOLLOW-UP CARE AFTER PRIAPISM TREATMENT: A CONTEMPORARY EXPERIENCE AT A SINGLE INSTITUTION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Penis/Testis/Urethra: Benign Disease1 Apr 2015PD2-07 FUNCTIONAL OUTCOMES AND FOLLOW-UP CARE AFTER PRIAPISM TREATMENT: A CONTEMPORARY EXPERIENCE AT A SINGLE INSTITUTION Stephen Kappa, Elizabeth Green, Shreyas Joshi, Melissa Kaufman, and Doug Milam Stephen KappaStephen Kappa More articles by this author , Elizabeth GreenElizabeth Green More articles by this author , Shreyas JoshiShreyas Joshi More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , and Doug MilamDoug Milam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.190AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess functional outcomes and follow-up care after priapism treatment in a contemporary cohort of patients. METHODS Retrospective review of consecutive priapism cases at a single institution from January 2005 to June 2014 was performed utilizing an inpatient Urologic Surgery consultation database. After providing informed consent, patients completed a telephone survey consisting of the International Index of Erectile Function (IIEF)-15, Erection Hardness Score (EHS), and follow-up care since their last priapism episode. RESULTS There were 102 uniquely presenting cases of priapism during the study period from a total of 62 patients. Survey data was collected on 30 priapism cases (29.4% of total cases) from 13 patients (21.0% of total patients). Mean follow-up time from last priapism case was 30.1 +/- 25.6 months. Mean IIEF-15 was 37.9 +/- 21.3, with erectile function domain score of 13.9 +/- 11.5. Mean EHS was 3.7 +/- 0.7, with 2 patients reporting no erections during the followup period. The surveyed cohort was young (mean age 31.9 +/- 11.2 years) with sickle cell disease as the most common etiology (17 cases, 56% of cohort). Sickle cell patients reported similar functional outcomes (mean IIEF-15 of +/- 37.1 +/- 21.5, with erectile function domain score of 13.9 +/- 11.5) compared to patients with other priapism etiologies (mean IIEF-15 of +/- 38.8 +/- 22.7, with erectile function domain score of 13.9 +/- 11.8). Only two patients experienced additional episodes of priapism. Hematoma was reported after 16.7% of cases. Less than half of patients (36.7%) ultimately saw a urologic surgeon in follow-up. CONCLUSIONS Long-term functional outcomes and follow-up from this large priapism case series reveals mild to moderate erectile dysfunction in a relatively young surveyed cohort with sickle cell disease as the predominant priapism etiology. Patients reported rare subsequent priapism episodes, relatively few complications after treatment, and poor urologic follow-up. This study demonstrates the feasibility of obtaining long-term follow-up data on priapism patients and provides a framework for further studies. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e42 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Kappa More articles by this author Elizabeth Green More articles by this author Shreyas Joshi More articles by this author Melissa Kaufman More articles by this author Doug Milam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Anticipating the Impact of Insurance Expansion on Inpatient Urological Surgery

IntroductionThe Affordable Care Act is expected to provide coverage for nearly 25 million previously uninsured individuals. Because the potential impact of the ACA on urological care remains unknown, we estimated the impact of insurance expansion on the use of inpatient urological surgeries using Massachusetts health care reform as a natural experiment. MethodsWe identified nonelderly patients who underwent inpatient urological surgery from 2003 through 2010 using inpatient databases from Massachusetts and 2 control states. Using July 2007 as the transition point between pre-reform and post-reform periods, we performed a difference-in-differences analysis to estimate the effect of insurance expansion on overall and procedure specific rates of inpatient urological surgery. We also performed subgroup analyses according to race, income and insurance status. ResultsWe identified 1.4 million surgeries performed during the study interval. We observed no change in the overall rate of inpatient urological surgery for the Massachusetts population as a whole. However, we saw an increase in the rate of inpatient urological surgery for nonwhite and low income patients. Our difference-in-differences analysis confirmed these results (all patients 1.0%, p=0.668; nonwhite patients 9.9%, p=0.006; low income patients 6.6%, p=0.041). At a procedure level insurance expansion caused increased rates of inpatient benign prostatic hyperplasia procedures but had no effect on rates of prostatectomy, cystectomy, nephrectomy, pyeloplasty or percutaneous nephrolithotomy. ConclusionsInsurance expansion in Massachusetts increased the overall rate of inpatient urological surgery only for nonwhite patients and low income patients. These data inform key stakeholders about the potential impact of national insurance expansion for a large segment of urological care.

MP6-13 INSURANCE EXPANSION AND THE UTILIZATION OF INPATIENT UROLOGICAL SURGERY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2014MP6-13 INSURANCE EXPANSION AND THE UTILIZATION OF INPATIENT UROLOGICAL SURGERY Chad Ellimoottil, Sarah Miller, John Wei, and David Miller Chad EllimoottilChad Ellimoottil More articles by this author , Sarah MillerSarah Miller More articles by this author , John WeiJohn Wei More articles by this author , and David MillerDavid Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.247AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is anticipated that the Affordable Care Act (ACA) will provide coverage for nearly 25 million previously uninsured individuals in the United States. Because the potential impact of the ACA for urological care delivery remains unknown, we used Massachusetts (MA) healthcare reform as a natural experiment to estimate the impact of insurance expansion on the utilization of inpatient urologic surgeries. METHODS We used discharge data from MA and two control states (New Jersey and New York) to identify nonelderly patients (19-64 years) who underwent inpatient urologic surgery from 2003 through 2010. Using July 2007 as the transition point between pre and post-reform periods, we performed a difference-in-differences (DID) analysis to estimate the effect of insurance expansion on overall and procedure-specific rates of inpatient urological surgery. We also performed subgroup analyses according to race, income and insurance status. RESULTS We identified 1.5 million surgeries performed during the study interval. We observed no increase in the overall rate of inpatient urologic surgery for the entire MA population, but an increase in the rate of inpatient urologic surgery for nonwhite and low income patients (Figure). Our DID analysis confirmed these results (all 2.0%, p=0.431; nonwhites 10.6%, p=0.003; low income 8.1% , p=0.009). At a procedure level, insurance expansion caused increased rates of partial nephrectomy and inpatient BPH procedures, but had no effect on rates of radical prostatectomy, cystectomy, nephrectomy, pyeloplasty or PCNL. CONCLUSIONS Although the effect on individual procedures is variable, insurance expansion in Massachusetts increased the overall rate of inpatient urologic surgery for nonwhites and low income patients. These data inform urologists and specialty societies about the potential impact of national insurance expansion for a key aspect of urological care. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e61 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Chad Ellimoottil More articles by this author Sarah Miller More articles by this author John Wei More articles by this author David Miller More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Sequential compression devices in postoperative urologic patients: an observational trial and survey study on the influence of patient and hospital factors on compliance

BackgroundSequential compression devices (SCDs) are commonly used for thromboprophylaxis in postoperative patients but compliance is often poor. We investigated causes for noncompliance, examining both hospital and patient related factors.Methods100 patients undergoing inpatient urologic surgery were enrolled. All patient had SCD sleeves placed preoperatively. Postoperative observations determined SCD compliance and reasons for non-compliance. Patient demographics, length of stay, inpatient unit type, and surgery type were recorded. At discharge, a patient survey gauged knowledge and attitudes regarding SCDs and bother with SCDs. Statistical analysis was performed to correlate SCD compliance with patient demographics; patient knowledge and attitudes regarding SCDs; and patient self-reported bother with SCDs.ResultsObserved overall compliance was 78.6%. The most commonly observed reasons for non-compliance were SCD machines not being initially available on the ward (71% of non-compliant observations on post-operative day 1) and SCD use not being restarted promptly after return to bed (50% of non-compliant observations for entire hospital stay). Mean self-reported bother scores related to SCDs were low, ranging from 1–3 out of 10 for all 12 categories of bother assessed. Patient demographics, knowledge, attitudes and bother with SCD devices were not significantly associated with non-compliance.ConclusionsPatient self-reported bother with SCD devices was low. Hospital factors, including SCD machine availability and timely restarting of devices by nursing staff when a patient returns to bed, played a greater role in SCD non-compliance than patient factors. Identifying and addressing hospital related causes for poor SCD compliance may improve postoperative urologic patient safety.

Inpatient Urological Surgery at Critical Access Hospitals in the United States

To better understand urological care delivery in rural communities, we evaluated the utilization, outcomes and costs of inpatient urological surgery at critical access hospitals. Using data from the AHA (American Hospital Association) and NIS (Nationwide Inpatient Sample), we identified all urological surgical admissions to critical and noncritical access hospitals from 2005 through 2009. We compared the distribution of urological procedures, hospital mortality, length of stay and costs for patients undergoing common urological operations at critical vs noncritical access hospitals. Of the 1,292 critical and 3,760 noncritical access hospitals reporting to the AHA 450 (35%) and 1,372 (36%), respectively, had at least 1 year of data available in the NIS. We identified 333,925 urological surgical admissions, including 2,286 (0.7%) to critical access hospitals. Overall, at least 1 inpatient urological operation was performed at only 45% of critical access hospitals vs 91% of noncritical access hospitals (p <0.001). The distribution of urological surgeries differed between critical and noncritical access hospitals (p <0.001) with a greater prevalence of operations for benign indications at critical access hospitals. For 6 common inpatient urological surgeries we found no meaningful difference in in-hospital mortality and prolonged length of stay between patients treated at critical vs noncritical access hospitals. However, costs at critical access hospitals were universally higher. Inpatient urological surgery is performed at only a few critical access hospitals. While in-hospital mortality and length of stay are largely indistinguishable between critical and noncritical access hospitals, the higher costs at critical access hospitals may pose a challenge to improving rural access to urological care.

Prospective Pilot Study of Smoking Cessation in Patients Undergoing Urologic Surgery

To evaluate whether preoperative smoking cessation counseling by urologists using the Ask, Advise, and Refer approach was effective in producing abstinence in patients undergoing urologic surgery. Smokers who were scheduled for inpatient urologic surgery were prospectively enrolled. Smoking cessation counseling consisted of an Ask, Advise, Refer approach. Validated smoking questionnaires were used to evaluate smoking cessation. The expired carbon monoxide and urine cotinine levels were measured to biochemically confirm short- and long-term smoking abstinence, respectively. A total of 38 patients were enrolled in the present study. A significant majority (76%) expressed a willingness to quit smoking long-term at enrollment. On the day of surgery, 9 (28%) of 32 patients reported having quit smoking. However, only 4 (13%) of 32 patients had biochemical confirmation of smoking cessation (negative carbon monoxide and urine cotinine). Similarly, at the first postoperative visit, 8 (29%) of 28 patients reported having quit smoking. However, only 4 (14%) of the 28 patients had biochemical confirmation of smoking cessation (negative carbon monoxide and urine cotinine levels). Despite these results, 89% of the patients continued to express their interest in smoking cessation. The preliminary results of the present pilot study have indicated that the short-term perioperative smoking cessation rates are modest at best. Alternative or supplemental modalities might be necessary to achieve better results and the ultimate goal of long-term smoking abstinence.