Minimally-invasive Prostatectomy Research Articles

Operative duration as independent predictor of increased postoperative healthcare utilization.

Few studies have examined the risk factors for postoperative healthcare resource utilization (HRU) among minimally invasive partial nephrectomy (MIPN), minimally invasive prostatectomy (MIP), and cystectomy (Cx). The aim of this study is to assess if operative duration (OD) is a predictor of HRU in this population. The ACS-NSQIPdatabase was filtered for MIPN, MIP, and Cx. Patient characteristics and intraoperative variableswere examined. HRU was defined as prolonged length of stay (LOS), unplanned readmission within 30days, and discharge to continued care facility. Multivariate regression analysis was used to identify independent predictors of HRU. 18,904 MIPN, 50,807 MIP, and 12,451 Cx were included. For MIPN, HRU was seen in 13.9% of cases < 1.75h, increasing to 36.2% in OD > 4.5h (p < 0.001). For MIP, HRU was seen in 10.6% of OD < 2h, increasing to 32.2% for OD > 4.9h (p < 0.001). For Cx, 57% of those with OD > 8.5h required HRU compared to 42.1% for OD < 3.3h (p < 0.001). On multivariate analyses, OD wasan independent predictor for increased HRU for all procedures regardless of patient characteristics or comorbidities. For MIPN, OD > 4.5h had 3.5-fold increased use of HRU (p < 0.001). For MIP, OD > 5h had 3.7-fold increased use of HRU (p < 0.001). For Cx, OD > 8.5h demonstrated a twofold increased use of HRU (p < 0.001). OD during MIPN, MIP, and Cx is an independent predictor of increased HRU irrespective of patient comorbidities. Patients with OD > 4.5h for MIPN, > 5h for MIP, and > 8.5h for Cx have 3.5-fold, 3.7-fold, and twofold increased risk of HRU, respectively.

MP17-16 OPERATIVE DURATION DURING UROLOGY ONCOLOGIC CASES AS INDEPENDENT PREDICTOR OF INCREASED POSTOPERATIVE HEALTHCARE UTILIZATION

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures I (MP17)1 Sep 2021MP17-16 OPERATIVE DURATION DURING UROLOGY ONCOLOGIC CASES AS INDEPENDENT PREDICTOR OF INCREASED POSTOPERATIVE HEALTHCARE UTILIZATION Jacqueline Morin, Amber Bettis, and Andrew Harris Jacqueline MorinJacqueline Morin More articles by this author , Amber BettisAmber Bettis More articles by this author , and Andrew HarrisAndrew Harris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002002.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent literature across a spectrum of surgical specialties has identified operative duration (OD) as an important predictor of increased postoperative complications and costs. In Urology, oncologic cases including minimally-invasive partial nephrectomy (MIPN), minimally-invasive prostatectomy (MIP), and cystectomy (Cx) rank among the most common major cases performed by urologists. Few studies have examined modifiable risk factors for postoperative healthcare resource utilization (HRU) among these particular cases. The aim of this study was to assess if OD is a predictor of HRU in this population. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was filtered for MIPN, MIP, and Cx from 2012-2018. Patient characteristics, presence of comorbid conditions, postoperative complications, and HRU were recorded. HRU was defined as prolonged length of stay (LOS), unplanned readmission <30 days after surgery, and discharge destination other than home. These factors were compared against OD using multivariate regression to identify independent predictors of HRU. RESULTS: 18,904 MIPN, 50,807 MIP, and 12,451 Cx were included. For MIPN, HRU was seen in 13.9% of cases <1.75h, increasing to 36.2% in OD >4.5h (p <0.001). For MIP, HRU was seen in 10.6% of OD <2h, increasing to 32.2% for OD >4.9h (p <0.001). For Cx, up to 57% of those with OD >8.5h required HRU compared to 42.1% for OD <3.3h (p <0.001). Using multivariate analyses, OD was found to be an independent predictor for increased HRU for all procedures regardless of patient characteristics or comorbidities. For MIPN, OD >4.5h had a nearly 3.5-fold increased use of HRU compared to shorter OD (p <0.001). For MIP, OD >5h carried a 3.7-fold increased use of HRU (p <0.001). For Cx, OD >8.5h demonstrated a 2-fold increased use of HRU (p <0.001). Figure 1. CONCLUSIONS: OD during MIPN, MIP, and Cx is an independent predictor of increased HRU irrespective of patient comorbidities. Patients with OD >4.5h for MIPN, >5h for MIP, and >8.5h for Cx have 3.5-fold, 3.7-fold, and 2-fold increased risk of HRU, respectively. This information can be used in the post-operative setting to anticipate patient needs and ultimately improve patient outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e314-e314 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacqueline Morin More articles by this author Amber Bettis More articles by this author Andrew Harris More articles by this author Expand All Advertisement Loading ...

MP19-16 UNDERSTANDING THE RISKS OF SURGERY IN UROLOGIC PATIENTS WITH LOW RISK CANCERS: QUANTIFYING PERIOPERATIVE CARDIOPULMONARY EVENTS FOLLOWING MINIMALLY INVASIVE PROSTATECTOMY AND PARTIAL NEPHRECTOMY

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP19)1 Sep 2021MP19-16 UNDERSTANDING THE RISKS OF SURGERY IN UROLOGIC PATIENTS WITH LOW RISK CANCERS: QUANTIFYING PERIOPERATIVE CARDIOPULMONARY EVENTS FOLLOWING MINIMALLY INVASIVE PROSTATECTOMY AND PARTIAL NEPHRECTOMY 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.0000000000002004.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The choice between active surveillance (AS) and surgical treatment for patients with newly diagnosed low risk malignancies is complex. To inform this nuanced decision, we quantify the incidence of postoperative cardiopulmonary events (CPEs) and the association of CPEs with readmission, reoperation, and length of stay following minimally invasive prostatectomy (MIP) and partial nephrectomy (MIpN). METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for patients undergoing MIP and MIpN from 2015 to 2019. Cardiopulmonary events included pneumonia, deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, myocardial infarction (MI), cardiovascular arrest, and death. Proportions were compared with the Chi-squared test and continuous measures compared with the Wilcoxon rank-sum test. To test for an association of CPEs with readmission, reoperation, and length of stay, we fit multivariable logistic and negative binomial regression models adjusting for clinical and demographic factors. RESULTS: A total of 64,975 patients undergoing MIP (46,869) and MIpN (18,106) met inclusion criteria, of which 1,160 patients (1.8%) had a cardiopulmonary event and included 87 deaths. Within 30 days of the index surgery, 2,876 patients (4.4%) were readmitted and 872 (1.3%) underwent reoperation. Patients with postoperative CPEs harbored a significantly higher risk of readmission (44.7% vs. 3.7%, p<0.001), reoperation (10.3% vs. 1.2%, p<0.001), and longer postoperative length of stay (2 days vs. 1 day, p<0.001) compared with patients without CPEs. After adjustment, perioperative cardiopulmonary events were associated with readmission (OR 20.1, 95% CI 17.7-22.8, p<0.001), reoperation (OR 8.94, 95% CI 7.25-11.0, p<0.001), and length of stay (IRR 2.37, 95% CI 2.21-2.55, p<0.001) in the multivariable models. CONCLUSIONS: Risks of serious cardiopulmonary postoperative events after MIP and MIpN are rare, but similar to risks of a cancer-specific mortality for patients with low risk prostate and renal cancer. Yet, such perioperative risks are immediate, while oncologic risks are delayed. This information should be integrated into the shared decision-making process in patients with neoplasms for which active surveillance has been established as an oncologically safe option. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e334-e334 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 ...

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

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 ...

The Effect of Obesity on Perioperative Outcomes for Open and Minimally Invasive Prostatectomy

To compare the impact of obesity on perioperative outcomes between open radical prostatectomy (ORP) and minimally invasive prostatectomy (MIP). Using the National Surgical Quality Improvement Program public use files for 2008-2013, we identified patients undergoing prostatectomy using Current Procedural Terminology codes. Those without body mass index (BMI) or comorbidity information were excluded. BMI was treated as a categorical variable according to the World Health Organization classification. Demographic and comorbid conditions were compared between BMI groups, and multivariable logistical regression was used to identify independent predictors of adverse perioperative events. We identified 17,693 MIP and 4674 ORP for analysis. Of the entire cohort, only 18.7% had a BMI within the normal range (18.5-24.9), whereas the remaining 81.3% were at least overweight (BMI > 25). Class I, II, and III obesity accounted for 25.0%, 7.0%, and 2.3% of the cohort, respectively. Overall, complications were higher with ORP (19.0%) than with MIP (5.3%), which held true across all BMI categories. The rate of wound, renal, thromboembolic, infectious, neurologic, Clavien grade III-V, and overall complications among MIP were directly related to BMI. Only wound and renal complications were related to BMI in ORP. In multivariable analysis, obesity was found to be an independent predictor of wound, renal, and thromboembolic complications. Obesity has a larger impact on morbidity for MIP compared to ORP. Overall morbidity, however, remains lower for MIP across all BMI groups.

Impact of Increasing Prevalence of Minimally Invasive Prostatectomy on Open Prostatectomy Observed in the National Inpatient Sample and National Surgical Quality Improvement Program

Laparoscopic and especially robot-assisted minimally invasive prostatectomy (MIP) has increased in popularity over the past decade. We analyzed how the increasing prevalence of MIP has affected the outcomes of MIP and open radical prostatectomy (RRP). In the Nationwide Inpatient Sample, 23,473 patients undergoing MIP and 118,266 undergoing RRP between 2002 and 2008 are reported. We analyzed length of stay (LOS), hospital charges (THC), complication rates (CR), and socioeconomic characteristics. We used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to identify complication rates (RRP n=666, and MIP n=2205). The proportion of MIP increased from 1.4% in 2002 to 29.5% in 2008. Mean LOS decreased for MIP (2.4 days in 2002, 1.6 days in 2008) and RRP (3.1 days in 2002, 2.1 days in 2008). Mean THC for MIP decreased ($46k in 2002, $34k in 2008) and increased for RRP ($18k in 2002, $32k in 2008). After 2005, overall CRs of MIP were lower than for RRP. High-volume centers reported lower CRs for both procedures. MIP was associated with fewer transfusions and wound complications. Men living in ZIP codes with the top quartile of yearly mean household income were more likely to undergo MIP than RRP (P<0.001). Although there were more white patients receiving MIP and black or Hispanic patients more frequently underwent RRP, there was no statistically significant difference. Increasing use of MIP led to decreased hospital stay for all patients, increase charges for RRP, and decreased CRs for both MIP and RRP. In recent years, MIP was associated with fewer complications. Charges for RRP have increased over time to approach those for MIP, and patients with increased socio-economic status were more likely to undergo MIP.