Risk Of 30-day Complications Research Articles

Obesity is highly associated with a non-home discharge following total ankle arthroplasty

Studies have shown that non-home discharge following orthopedic procedures is associated with a higher risk of 30-day complications and significantly increases medical costs. The purpose of this study was to identify risk factors for being discharged to a non-home destination following total ankle arthroplasty (TAA).We included patients undergoing TAA from the American College of Surgeons National Surgical Quality Improvement Program database (NSQIP) between 2014 and 2019. TAA was identified using CPT codes 27702, 27703 and 27704. Logistic regression models were used to assess the association between discharge location (home versus non-home) and a series of exposure variables (e.g., patient demographics, patient health characteristics, and operative factors).A total of 1,704 patients were included, experiencing a 3.6% short term complication rate (61/1,704). 8.5% of the population were discharged to a non-home destination. In the final adjusted model, patients who were older [OR 1.11; 95%CI 1.08, 1.13], female [OR 2.94; 95%CI 2.04, 4.34], obese [OR 1.93; 95%CI 1.29, 2.89], had surgery in an inpatient setting [OR 5.73; 95%CI 1.78, 18.46], and ASA class IV [OR 10.65; 95%CI 1.03, 110.61] were at greater risk for a non-home discharge.People living with obesity experienced a nearly 2x greater likelihood of being discharged to a non-home destination after TAA despite their preoperative functional (e.g., ASA class) and metabolic status (i.e., diabetes). Opportunities to mitigate this risk will be needed to lessen the financial burden of TAA surgery as a growing number of obese patients become eligible for TAA in the US.

Utility of Risk Analysis Index for Assessing Morbidity in Patients Undergoing Posterior Spinal Fusion for Adult Spinal Deformity

This study investigates the predictive values of the Risk Analysis Index (RAI), the modified 5-item Frailty Index (mFI-5), and advanced age for predicting 30-day extended length of stay (LOS), 30-day complications and readmissions in patients undergoing posterior spinal fusion (PSF) for adult spinal deformity (ASD). A retrospective cohort study was performed using the 2012-2021 ACS NSQIP database. Adults undergoing posterior spinal fusion for ASD were identified using CPT and ICD codes. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent associations of RAI, mFI-5, and greater patient age for extended LOS, 30-day complications and readmissions. In this cohort of 3,814 patients, RAI identified 90.7% as Robust, 6.0% as Normal, and 3.3% as Frail/Very Frail, while mFI-5 classified 47.1% as Robust, 37.5% as Normal, and 15.3% as Frail/Very Frail. Multivariate analysis revealed both RAI and mFI-5 as significant predictors of extended LOS for Normal (RAI: p<0.001; mFI-5: p=0.012) and Frail/Very Frail patients (RAI: p<0.001; mFI-5: p=0.002). Additionally, RAI was a significant predictor of 30-day complication risk for Normal patients (p=0.005). Furthermore, mFI-5 was a significant predictor of 30-day readmission among Frail/Very Frail patients (p=0.002). This study highlights the utility of RAI and mFI-5 in predicting extended LOS patients undergoing PSF for ASD. RAI was found to be superior to mFI-5 for predicting 30-day readmissions, while mF-5 was greater for 30-day complications. These findings highlight the importance of incorporating frailty assessments into preoperative surgical planning.

Assessing a revised-risk analysis index for morbidity and mortality after spine surgery for metastatic spinal tumors.

Risk Analysis Index (RAI) has been increasingly used to assess surgical frailty in various procedures, but its effectiveness in predicting mortality or in-patient hospital outcomes for spine surgery in metastatic disease remains unclear. The aim of this study was to compare the predictive values of the revised RAI (RAI-rev), the modified frailty index-5 (mFI-5), and advanced age for extended length of stay, 30-day readmission, complications, and mortality among patients undergoing spine surgery for metastatic spinal tumors. A retrospective cohort study was performed using the 2012-2022 ACS NSQIP database to identify adult patients who underwent spinal surgery for metastatic spinal pathologies. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent associations of RAI-rev, mFI-5, and greater patient age with extended length of stay (LOS), 30-day complications, hospital readmission, and mortality. A total of 1,796 patients were identified, of which 1,116 (62.1%) were male and 1,008 (70.7%) were non-Hispanic White. RAI-rev identified 1,291 (71.9%) frail and 208 (11.6%) very frail patients, while mFI-5 identified 272 (15.1%) frail and 49 (2.7%) very frail patients. In the ROC analysis for extended LOS, both RAI-rev and mFI-5 showed modest predictive capabilities with area under the curve (AUC) values of 0.5477 and 0.5329, respectively, and no significant difference in their predictive abilities (p = 0.446). When compared to age, RAI-rev demonstrated superior prediction (p = 0.015). With respect to predicting 30-day readmission, no significant difference was observed between RAI-rev and mFI-5 (AUC 0.5394 l respectively, p = 0.354). However, RAI-rev outperformed age (p = 0.001). When assessing the risk of 30-day complications, RAI-rev significantly outperformed mFI-5 (AUC: 0.6016 and 0.5542 respectively, p = 0.022) but not age. Notably, RAI-rev demonstrated superior ability for predicting 30-day mortality compared to mFI-5 and age (AUC: 0.6541, 0.5652, and 0.5515 respectively, p < 0.001). Multivariate analysis revealed RAI-rev as a significant predictor of extended LOS [aOR: 1.96, 95% CI: 1.13-3.38, p = 0.016] and 30-day mortality [aOR: 5.27, 95% CI: 1.73-16.06, p = 0.003] for very frail patients. Similarly, the RAI-rev significantly predicted 30-day complications for frail [aOR: 2.63, 95% CI: 1.21-5.72, p = 0.015] and very frail [aOR: 3.69, 95% CI: 1.60-8.51, p = 0.002] patients. However, the RAI did not significantly predict 30-day readmission [Very Frail aOR: 1.52, 95% CI: 0.75-3.07, p = 0.245; Frail aOR: 1.46, 95% CI: 0.79-2.68, p = 0.225]. Our study demonstrates the utility of RAI-rev in predicting morbidity and mortality in patients undergoing spine surgery for metastatic spinal pathologies. Particularly, the superiority that RAI-rev has in predicting 30-day mortality may have significant implications in multidisciplinary decision making.

Advanced Non-linear Modeling and Explainable Artificial Intelligence Techniques for Predicting 30-Day Complications in Bariatric Surgery: A Single-Center Study.

Metabolic bariatric surgery (MBS) became integral to managing severe obesity. Understanding surgical risks associated with MBS is crucial. Different scores, such as the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), aid in patient selection and outcome prediction. This study aims to evaluate machine learning (ML) models performance in predicting 30-day post-operative complications and compare them with the MBSAQIP risk score. We retrospectively evaluated 424 consecutive patients (2006-2020) who underwent MBS, analyzing 30-day surgical complications according to Clavien-Dindo Classification. ML models, including logistic regression, support vector machine, random forest, k-nearest neighbors, multi-layer perceptron, and extreme gradient boosting, were analyzed and compared to MBSAQIP risk score. Performance was measured by area under receiver operating characteristic curve (AUROC) analysis. Random forest showed the highest AUROC in the training (AUROC = 0.94) and the validation set (AUROC = 0.88). ML algorithms, particularly random forest, outperformed MBSAQIP in predicting negative 30-day outcomes in both the training and validation sets (AUROC = 0.64, DeLong's Test p < 0.001). The five features that were more relevant for the prediction of the random forest model were serum alkaline phosphatase, platelet count, triglycerides, glycated hemoglobin, and albumin. We developed several ML model that identifies patients at risk for 30-day complications after MBS. Among these, random forest is the most performing one and outperforms the already established MBSAQIP score. This model could increase the identification of high-risk patients before MBS.

Contemporary morbidity and mortality of open versus robotic cystectomy for bladder cancer: An analysis of the National Surgical Quality Improvement Program (NSQIP) procedure targeted cystectomy database

ObjectivesTo evaluate the association between surgical modality (RARC vs. ORC) and the risk of 30-day complications. Materials and MethodsWe utilized the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Cystectomy-Targeted database from 2019 to 2021. The primary outcome was a composite of major complications including 30-day mortality, reoperation, cardiac events, and stroke. Secondary outcomes included individual major and cystectomy-specific complications. Propensity score matching (PSM) was employed to minimize inherent differences within our cohort. We performed logistic regression to assess the association between outcomes of interest and operative modality. ResultsWe found no difference between operative modality and the primary outcome, however, RARC was associated with a 70% lower risk of 30-day mortality (OR 0.30, 95% CI 0.13-0.70) and had favorable outcomes with respect to respiratory, deep venous thrombosis, wound complications, and length of stay. Limitations are related to residual confounding given the observational methodology. ConclusionsRARC was associated with reduced risk of multiple 30-day complications, including mortality, as well as organ system and cystectomy-specific outcomes. These data support the clinical benefit of increased adoption of RARC.

Impact of Resident Involvement on 30-Day Postoperative Outcomes in Orthopedic Shoulder Surgery.

The literature concerning resident involvement in shoulder surgery is limited. The purpose of this study was to examine whether resident involvement across all orthopedic shoulder surgeries is associated with adverse 30-day outcomes. Utilizing the American College of Surgeons National Surgical Quality Improvement Program database, patients who underwent shoulder surgery with or without a resident present were analyzed. Independent t-test and chi-square or Fischer's exact test were used appropriately. A logistic regression model was used to calculate adjusted odds ratios. This study examined 5,648 patients: 3,455 patients in the "Attending alone" group and 2,193 in the "Attending and resident in the operating room" group. Resident presence in the operating room was not associated with increased complications, except for bleeding transfusions (OR 1.71, CI 1.32-2.21, P ≤ 0.001). This study demonstrates that resident involvement in orthopedic shoulder surgery does not present an increased risk for 30-day complications when compared to surgeries performed with the attending surgeon alone.

The Association of Weight With Surgical Morbidity in Infants Undergoing Enterostomy Reversal: A Study of the NSQIP-Pediatrics Database

IntroductionOptimal criteria and timing for enterostomy closure (EC) in neonates is largely based on clinical progression and adequate weight, with most institutions using 2.0–2.5 kg as the minimum acceptable weight. It is unclear how the current weight cutoff affects post-operative morbidity. AimTo determine how infant weight at the time of EC influences 30-day complications. MethodsInfants weighing ≤4000 g who underwent EC were identified in the 2012–2019 ACS NSQIP-P database. Demographics, comorbidities, and 30-day outcomes were assessed using univariate analysis. Multivariable logistic regression controlling for ASA score, nutritional support, and ventilator support was used to estimate the independent association of weight on risk of 30-day complications. ResultsA total of 1692 neonates from the NSQIP-P database during the years 2012–2019 met inclusion criteria. Neonates weighing <2.5 kg were significantly more likely to have a younger gestational age, require ventilator support, and have concurrent comorbidities. Major morbidity, a composite outcome of the individual postoperative complications, was observed in 283 (16.7%) infants. ASA classifications 4 and 5, dependence on nutritional support, and ventilator support were independently associated with increased risk of 30-day complications. With respect to weight, we found no significant difference in major morbidity between infants weighing <2.5 kg and infants weighing ≥2.5 kg. ConclusionDespite using a robust, national dataset, we could find no evidence that a defined weight cut-off was associated with a reduction in major morbidity, indicating that weight should not be a priority factor when determining eligibility for neonatal EC. Level of EvidenceIII.

Complications Following Gender-Affirming Phalloplasty: A NSQIP Review

Abstract Background Gender-affirming phalloplasty has a complication rate as high as 76.5%. This is the first study to determine the predictors of 30-day complications following phalloplasty using a national registry. Methods The National Surgical Quality Improvement Program database (2012–2021) was queried for transgender men and Current Procedural Terminology codes pertaining to flap or microsurgery procedures to select for single- and first-stage phalloplasty cases. Included were patients with a length of total hospital stay ≥ 5 days and operating time &gt; 4 hours to select for primary phalloplasty cases. The primary outcome was incidence of major and minor complications, and the secondary outcome was indication for unplanned reoperation. Bivariate analysis and multivariate logistic regression were performed to determine significant predictors of complications. Results Of 90 patients, 18 (20.0%) patients developed at least one complication. The most common complication was unplanned reoperation (n = 10, 11.1%) due to hematoma evacuation (n = 3, 30.0% of reoperations, 3.3% of all patients). A total of 43 (47.8%) underwent single-stage phalloplasty, and 47 (52.2%) underwent first-stage phalloplasty. Compared with patients without complications, those with minor complications are more likely to have had single-stage phalloplasty (n = 37 [45.1%], n = 6 [75.0%]; p = 0.145), but the association was not statistically significant. Longer operating time was associated with greater odds of major complications (adjusted odds ratio [aOR] 95% confidence interval [CI] 1.01 [1.002–1.018]). Patients who smoked within 1 year of surgery had 123 times the odds of 30-day minor complications (surgical site infection, urinary tract infection, wound dehiscence, pneumonia) compared with nonsmokers (aOR [CI] 123.3 [1.4– &gt; 100.0]). Conclusion There were no significant differences in complication rates between single- and first-stage phalloplasties. Patients should be counseled about the overall risk of 30-day complications following phalloplasty. Reducing operating time, smoking cessation, and strict preoperative nicotine testing may assist in mitigating odds of 30-day complications following phalloplasty.

Does the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program bariatric risk/benefit calculator hold its weight? An assessment of its accuracy

BackgroundBariatric clinical calculators have already been implemented in clinical practice to provide objective predictions of complications and outcomes. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Surgical Risk/Benefit Calculator is the most comprehensive risk calculator in bariatric surgery. ObjectivesEvaluate the accuracy of the calculator predictions regarding the 30-day complication risk, 1-year weight loss outcomes, and comorbidity resolution. SettingMBSAQIP-accredited center. MethodsAll adult patients who underwent primary laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy at our institution between 2012 and 2019 were included. Baseline characteristics were used to generate the individualized outcome predictions for each patient through the bariatric risk calculator and were compared to actual patient outcomes. Statistical analysis was performed using c-statistics, linear regression models, and McNemmar chi-square test. ResultsOne thousand four hundred fifty-three patients with a median age of 45 (37, 55) and consisting of 80.1% females were included in the study. The c-statistics for the complications and comorbidity resolution ranged from .533 for obstructive sleep apnea remission to .675 for 30-day reoperation. The number of comorbidity resolutions predicted by the calculator was significantly higher than the actual remissions for diabetes, hyperlipidemia, hypertension and obstructive sleep apnea (P < .001). On average, the calculator body mass index (BMI) predictions deviated from the observed BMI measurement by 3.24 kg/m2. The RYGB procedure (Coef −.89; P = .005) and preoperative BMI (Coef −.4; P = .012) were risk factors associated with larger absolute difference between the predicted and observed BMI. ConclusionsThe MBSAQIP Surgical Risk/Benefit Calculator prediction models for 1-year BMI, 30-day reoperation, and reintervention risks were fairly well calibrated with an acceptable level of discrimination except for obstructive sleep apnea remission. The 1-year BMI estimations were less accurate for RYGB patients and cases with very high or low preoperative BMI measurements. Therefore, the bariatric risk calculator constitutes a helpful tool that has a place in preoperative counseling.

Association of Age and Frailty With 30-Day Outcomes Among Patients Undergoing Oral Cavity Cancer Surgery.

To evaluate the impact of age and frailty on 30-day outcomes following surgery for oral squamous cavity carcinoma (OSCC). Retrospective cross-sectional analysis. American College of Surgeons' National Quality Improvement Program (NSQIP) database. Patients who underwent OSCC resection were queried via NSQIP (2015-2020). Cases were stratified by age (18-65, 65-75, and older than 75) as well as by modified frailty index scores (mFI 0, mFI 1, and mFI 2+) for comparative analyses. Univariate and multivariable analyses were conducted to examine demographics, perioperative outcomes, and 30-day postoperative adverse events. A total of 3238 patients who underwent OSCC surgery were identified and categorized as nongeriatric ("NGA," age 18-65), younger geriatric ("YGA," age 65-75), and older geriatric ("OGA," age >75) adults. Compared to NGA, geriatric patients had higher the American Society of Anesthesiologists classification, higher modified frailty index scores, and more comorbidities such as hypertension, congestive heart failure, chronic obstructive disease, and diabetes (p < .001). YGAs and OGAs were also less likely to undergo neck dissection (p < .001), composite resection (p = .006), and free flap reconstruction compared to NGAs (p < .001). When controlling for confounders, age was not independently associated with an increased risk of poor outcomes. On the other hand, frailty was found to be independently associated with a higher risk of adverse events (odds ratio: 1.40 [1.15-1.70], p < .001 for mFI 1, odds ratio: 1.45 [1.04-2.02], p = .027 for mFI 2+). A higher mFI score, not older age, is associated with an increased risk of 30-day complications following OSCC surgery.

Endovascular repair of acute vs. subacute uncomplicated type B aortic dissection: a systematic review and meta-analysis.

This study aimed to conduct a meta-analysis evaluating the optimal timing for endovascular repair of acute versus subacute uncomplicated Type B Aortic Dissection. PubMed, EMBASE, web of science and Cochrane Library was interrogated to identify Electronic bibliographic studies updated to January 2023 to collect studies compared the clinical outcomes of endovascular repair for Acute Versus Subacute Uncomplicated Type B Aortic Dissection. Data were aggregated as pooled odds ratios (OR) using the fixed or random effects models according to the significance of heterogeneity, Pooled odds ratios (OR) were calculated by RevMan 5.3 and applied with fixed or random-effect models. A comprehensive literature search found 322 citations published and finally among them 6 studies containing 3,769 patients (acute group 2,642, subacute group 1,127) were included in review. There is an increased risk of 30-day complications (OR = 1.51,95%CI,1.26-1.81) 30-day mortality (OR = 2.39,95%CI, 1.55-3.67) and 1-year mortality (OR = 1.71,95%CI,1.27-2.30) for an acute uTBAD group compared to subacute ones. Similarly, reintervention was more likely in the acute group than in the subacute group (OR = 1.42,95%CI,1.05-1.91). However, no significant differences were found in long-term mortality. This meta-analysis confirmed that there was no significant difference in the long-term prognosis between the acute and subacute phases in the timing of surgery. However, considering the high incidence of complications, high re-intervention rate and one-year mortality probably caused by high intima fragility in the acute phase, endovascular repair at subacute phase appears to favorably compare with acute strategy. But future studies with adequate patient numbers and longer-term follow-up are necessary to further verify the study conclusion. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021247609, identifier PROSPERO CRD42021247609.

Heightened 30-Day Postoperative Complication Risk Persists After COVID-19 Infection.

BackgroundCurrent literature describing the riskiness of operating on actively infected COVID-19 patients far outnumbers that on the risk of operating on recovered patients. The purpose of this study was to analyze a single, tertiary referral center experience regarding postoperative complications and readmissions in COVID-19-recovered patients versus COVID-19-naïve (never previously infected) patients undergoing elective and emergency surgery across all surgical subspecialties.MethodsAll PCR positive COVID-19 patients that underwent a surgical procedure between February 1, 2020, and November 1, 2020, were included in the COVID-positive cohort. These patients were then matched to COVID-naïve controls that underwent similar procedures within the same time frame. Primary outcomes included 30-day postoperative complications as well as 90-day readmissions. Multivariable analyses were also performed.Results112 COVID-positive patients met inclusion criteria and were all matched to COVID-naïve controls. 76 patients (68%) underwent surgery > 30 days from their COVID diagnosis. COVID-positive patients were at significantly higher risk of 30-day complications compared to the COVID-naïve cohort (22% versus 8%, respectively; p < 0.01). Multivariable analyses found ambulatory/asymptomatic infections, undergoing surgery between 30 and 120 days from diagnosis, initial presentation to the emergency department and elevated ASA scores to be significantly associated with 30-day complications. No differences were found for 90-day readmissions.ConclusionPatients with previous COVID-19 infections carry a higher perioperative risk profile for 30-day complications compared to COVID-naïve counterparts in unvaccinated populations.

High risk of complications after a "low risk" procedure: A national study of nursing home residents and older adults undergoing haemorrhoid surgery.

To evaluate 30-day complications and 1-year mortality for older adults undergoing haemorrhoid surgery. This retrospective cohort study evaluated older adults (age 66+) undergoing haemorrhoid surgery using Medicare claims and the minimum data set (MDS). Long-stay nursing home residents were identified, and propensity score matched to community-dwelling older adults. Generalized estimating equation models were created to determine the adjusted relative risk of 30-day complications, length of stay (LOS), and 1-year mortality. Among nursing home residents, functional and cognitive status were evaluated using the MDS-activities of daily living (ADL) score and the Brief Instrument of Mental Status. Faecal continence status was evaluated among a subset of nursing home residents. A total of 3664 subjects underwent haemorrhoid surgery and were included in the analyses. Nursing home residents were at significantly higher risk for 30-day complications (52.3% vs. 32.9%, aRR 1.6 [95% CI: 1.5-1.7], p < 0.001), and 1-year mortality (24.9% vs. 16.1%, aRR 1.6 [95% CI: 1.3-1.8], p < 0.001). Functional and mental status showed an inflection point of decline around the time of the procedure, which did not recover to the baseline trajectory in the following year. Additionally, a subset of nursing home residents demonstrated worsening faecal incontinence. This study demonstrated high rates of 30-day complications and 1-year mortality among all older adults (yet significantly worse among nursing home residents). Ultimately, primary care providers and surgeons should carefully weigh the potential harms of haemorrhoid surgery in older adults living in a nursing home.

Delayed discharge after total hip arthroplasty is associated with an increased risk of complications.

Background:The purpose of this study was to evaluate the influence of discharge timing on 30-day complication rates following total hip arthroplasty.Methods:We identified patients who underwent total hip arthroplasty between 2011 and 2017 from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Using propensity score matching, we matched patients who were discharged from the hospital on the day of surgery to those discharged on postoperative days 1, 2, 3 and 4, respectively. We used multivariable logistic regression to determine if the rates of complications and readmission differed depending on length of stay.Results:We identified 141 594 patients who underwent total hip arthroplasty (average age 64.7 [standard deviation (SD) 11.4] yr) from the NSQIP database. The average length of stay was 2.3 days and decreased from 2.8 (SD 0.7) days in 2011 to 1.9 (0.9) days in 2017. The adjusted odds of a major complication increased by 1.33 (1.09–1.61) and 1.41 (1.05–2.21) for patients discharged on postoperative day 3 and 4, respectively, compared with patients discharged on postoperative day 2. Similarly, the adjusted odds of a minor complication increased by 1.22 (1.03–1.43) and 1.58 (1.11–2.26) for patients discharged on postoperative days 3 and 4, respectively, compared with those discharged on postoperative day 2. We found no difference in the risk of major or minor complications between patients discharged on the day of surgery or postoperative day 1 compared with patients discharged on postoperative day 2. We also found that a length of stay of 3 or 4 days increased the risk of readmission (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.03–1.29, and OR 1.18, 95% CI 1.08–1.85, respectively) compared with a length of stay of 2 days.Conclusion:Our data suggest that discharge on postoperative days 0–2 is associated with the lowest risk of 30-day complications following total hip arthroplasty. These findings support early discharge after total hip arthroplasty; however, more prospective clinical data are required to determine the optimal length of stay following total hip arthroplasty.

The effect of obesity on complications following isolated posterior cruciate ligament reconstruction

BackgroundThis study assessed the risk of 30-day complications for obese patients compared to non-obese patients undergoing isolated posterior cruciate ligament (PCL) reconstruction. MethodsFrom 2006 to 2019, the National Surgical Quality Improvement Program database was queried for patients undergoing isolated PCL reconstruction. Two patient cohorts were defined: patients with obesity (BMI ≥ 30.0 kg/m2) and patients without obesity (BMI < 30 kg/m2). Patients’ baseline demographics and medical comorbidities were collected and compared between the cohorts. Postoperative outcomes were assessed using bivariate and multivariate analyses. Results414 patients underwent PCL reconstruction. 258 patients (62.3%) were non-obese and 156 patients (37.7%) were obese. Obese patients were more likely to be older, have a higher American Society of Anesthesiologists classification, and have hypertension compared to non-obese patients (p < 0.05 for all). The rates of superficial surgical site infections, wound dehiscence, transfusion necessity, deep vein thrombosis, and re-operation were not significant between obese and non-obese patients. Following adjustment on multivariate analyses, relative to patients without obesity, those with obesity had an increased risk of admission to the hospital overnight (OR 1.66; p = 0.048). ConclusionsTo our knowledge, this is the first study to evaluate obesity on complications in isolated PCL reconstruction. Our results and the heterogeneity in the literature indicate that obesity significantly impacts the rates of hospital readmission for PCL reconstruction. Therefore, surgeons should carefully weigh the risks and benefits of operating on obese patients and plan accordingly as obese patients may require postoperative hospital admission after PCL reconstruction.Level of Evidence: III.

Is it safe to administer neoadjuvant chemotherapy to patients undergoing hepatectomy for intrahepatic cholangiocarcinoma? ACS-NSQIP propensity-matched analysis.

The use of neoadjuvant chemotherapy (NAC) in patients with intrahepatic cholangiocarcinoma (iCCA) is increasing. The objective of this study was to compare the 30-day post-operative complications and length-of-stay (LOS) between patients undergoing hepatectomy for iCCA with and without NAC. A retrospective study was conducted using the ACS-NSQIP database queried from 2014 to 2018. Patients with NAC receipt were propensity-score matched into 1:3 ratio with controls using the greedy-matching algorithm and a caliper of 0.2. Logistic and Poisson regression models were used to estimate the effect sizes. A total of 1508 patients who underwent hepatectomy for iCCA were included. 706 patients remained after matching and balance were achieved. The NAC group had 110 (60.1%) complications vs. 289 (55.3%) complications in the non-NAC group (p=0.29). NAC was not associated with worse 30-day postoperative complications [OR 1.24, 95% CI: 0.87-1.76; p=0.24]. Post-operative LOS in the NAC group was 8.56 days (mean, SD 7.4) vs. non-NAC group 9.27 days (mean, SD 8.41, p=0.32). NAC was not associated with longer post-operative LOS [RR 0.93, 95% CI:0.80, 1.08; p=0.32]. NAC may be safely administered without increasing the risk of 30-day complications or post-operative hospital LOS.

Same-day discharge following minimally invasive partial and radical nephrectomy: a National Surgical Quality Improvement Program (NSQIP) analysis.

Minimally invasive partial nephrectomy (MIPN) and radical nephrectomy (MIRN) have successfully resulted in shorter length of stay (LOS) for patients. Using a national cohort, we compared 30-day outcomes of SDD (LOS = 0) versus standard-length discharge (SLD, LOS = 1-3) for MIRN and MIPN. All patients who underwent MIPN (CPT 50,543) or MIRN (CPT 50,545) in the ACS-NSQIP database from 2012 to 2019 were reviewed. SDD and SLD groups were matched 1:1 by age, sex, race, body mass index, American Society of Anesthesiologists score, and medical comorbidities. We compared baseline characteristics, 30-day Clavien-Dindo (CD) complications, reoperations, and readmissions between SDD and SLD groups. Multivariable logistic regressions were used to evaluate predictors of adverse outcomes. 28,140 minimally invasive nephrectomy patients were included (SDD n = 237 [0.8%], SLD n = 27,903 [99.2%]). There were no significant differences in 30-day readmissions, CD I/II, CDIII, or CD IV complications before and after matching SDD and SLD groups. On multivariate regression analysis, SDD did not confer increased risk of 30-day complications or readmissions for both MIPN and MIRN. SDD after MIPN and MIRN did not confer increased risk of postoperative complications, reoperation, or readmission compared to SLD. Further research should explore optimal patient selection to ensure safe expansion of this initiative.

MP52-14 ESTIMATED GLOMERULAR FILTRATION RATE PREDICTS ADVERSE OUTCOMES AMONG MEN UNDERGOING ARTIFICIAL URINARY SPHINCTER SURGERY

You have accessJournal of UrologyCME1 May 2022MP52-14 ESTIMATED GLOMERULAR FILTRATION RATE PREDICTS ADVERSE OUTCOMES AMONG MEN UNDERGOING ARTIFICIAL URINARY SPHINCTER SURGERY Carlos Riveros, Victor Chalfant, Ahmed Elshafei, and K.C. Balaji Carlos RiverosCarlos Riveros More articles by this author , Victor ChalfantVictor Chalfant More articles by this author , Ahmed ElshafeiAhmed Elshafei More articles by this author , and K.C. BalajiK.C. Balaji More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002627.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: More than 15% of the adult population in the US is estimated to have chronic kidney disease (CKD) defined as a glomerular filtration rate (GFR) below 60 ml/min/1.73 m2 for three months or longer. For men with moderate to severe urinary incontinence after prostatectomy, artificial urinary sphincter (AUS) is considered the gold standard treatment. The impact of CKD staging on postoperative complications after AUS surgery is not well defined. The goal of this study was to assess whether male patients with an estimated glomerular filtration rate (eGFR) that is higher or lower than population-based standards have an increased risk of 30-day complications after AUS surgery. METHODS: Using the American College of Surgeons National Improvement Quality Improvement Program (NSQIP) database, we identified adult males who underwent AUS surgery between 2006-2019. To calculate eGFR, the Modification of Diet in Renal Disease (MDRD) equation was utilized: eGFR (ml/min/1.73 m2) = 186 x serum Cr-1.154 x age-0.203 x 1.210 (if African American). Based on eGFR, patients were divided into five different groups: 0-29 (advanced CKD), 30-59 (Stage III CKD), 60-89 (Stage II CKD), 90-119 (Stage I CKD), and >120 (hyperfiltration). We investigated 30-day outcomes including readmission, reoperation, complications (both minor and major), and non-home discharge in all groups. A multivariate logistic regression analysis was performed to control for confounding variables and to identify eGFR categories as an independent risk factor for each outcome. RESULTS: A total of 2,410 cases met inclusion criteria. Overall, most patients were elderly, overweight, and had hypertension. Patients with advanced CKD had high rates of hypertension (84.4%) and diabetes (43.8%). Patients with advanced CKD had 9.9x higher odds of non-home discharge, 7.1x higher odds of minor complications, and 6.7x higher odds of major complications (p-value <0.05). CONCLUSIONS: Patients with non-advanced CKD had complication rates comparable to patients with better renal function. Patients with advanced CKD (eGFR<30) should be carefully selected prior to AUS surgery due to higher complication rates compared to patients with higher eGFR. Low eGFR may be used to counsel patients about risk for 30-day surgical complications. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e892 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlos Riveros More articles by this author Victor Chalfant More articles by this author Ahmed Elshafei More articles by this author K.C. Balaji More articles by this author Expand All Advertisement PDF DownloadLoading ...

Risks of chronic steroid or immunosuppressive therapy on total shoulder arthroplasty patients.

Patients on chronic corticosteroids/immunosuppressants (SI) undergoing orthopaedic surgery are at an increased risk for surgical complications and worse outcomes. However, whether or not chronic preoperative SI use increases the risk for 30-day complications in patients undergoing primary total shoulder arthroplasty (SA) has yet to be explored. From 2006 to 2019, the National Surgical Quality Improvement Program (NSQIP) database was used to identify all patients who underwent primary SA (anatomic TSA and reverse TSA). Patients were stratified into two cohorts: chronic preoperative SI users and those without use. Bivariate and multivariate analyses were utilized in this study. Of the 26,979 patients who underwent primary SA, 25,656 (95.1%) patients did not have SI usage whereas 1323 (4.9%) patients had chronic preoperative SI usage. Following adjustment on multivariate analyses, compared to the non-SI usage cohort, patients who used SI had an increased risk of urinary tract infections (UTIs) (OR 1.87; p = 0.009) and septic shock (OR 7.14; p = 0.002). There were no differences in mortality between the two cohorts (p = 0.058). Chronic pre-operative SI use is an independent risk factor for septic shock and UTIs following primary SA. Surgeons and patients should be aware of these risks to better inform patient counseling and surgical decision making.

This Month in Adult Urology

You have accessJournal of UrologyThis Month in Adult Urology1 Jun 2022This Month in Adult Urology D. Robert Siemens D. Robert SiemensD. Robert Siemens More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002499AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Lower Urinary Tract Symptoms and Increased Mortality in Men Lower urinary tract symptoms (LUTS) are common and frequently associated with significant bother and decreased quality of life in the aging male. However, there is some mounting evidence that severe LUTS could potentially serve as a prognostic factor for premature death with several theoretical relationships. Åkerla et al (page 1285) from Finland further explore this concept among middle-aged and elderly men utilizing population-based surveys spanning 1994–2018.1 Their analysis included 1,167 men and demonstrates an association of daytime frequency and nocturia with increased mortality. Although no cause-effect correlation can be inferred from these observations, the authors interestingly show this link between LUTS and mortality is independent of associated bother, which might be the more usual complaint to drive subsequent investigation and management. Frailty and Adverse Outcomes after Sling Surgery As our population ages, preoperative assessment and prehabilitation will become increasingly important to optimize outcomes for even mildly complex interventions. Increasing evidence has pointed to some evaluation of frailty, rather than simply age and co-morbid illness, as being more useful to assess postoperative sequelae in the elderly. Van Kuiken et al (page 1276) from San Francisco, California examine the impact of frailty on outcomes of sling surgery for stress urinary incontinence in all Medicare beneficiaries over 65 years of age.2 They observed that frailty is associated with an increased risk of 30-day complications, need for repeat procedures as well as 1-year mortality. The authors suggest that frailty should be strongly considered for an elderly woman considering the pros and cons of even such a relatively minor surgical procedure. A practical assessment of frailty such as TUG (Timed Up & Go) could be easily implemented in our clinics. Risk of an Elevated Hematocrit on Testosterone Therapy Despite direction from guidelines, it has been observed that routine assessment of bloodwork after initiation of testosterone therapy (TT) is less than ideal. One important potential adverse outcome that may then be missed is secondary erythrocytosis. Although this can be a common dose-limiting effect, there are few data that examine the association of a rising hematocrit and cardiovascular outcomes for those on TT. Ory et al (page 1295) from Miami, Florida and Halifax, Canada using a multi-institutional database explored these associations and demonstrate that the incidence of major adverse cardiovascular events or venous thromboembolic events was associated with developing erythrocytosis in the first year of TT.3 These results underscore the importance of assuring guideline-concordant followup for men on TT. The Impact of Hematuria after Post-Prostatectomy Radiotherapy Considerations of prostate cancer survivorship issues are paramount when counseling patients, perhaps specifically so when discussing the potential need for post-prostatectomy radiation. Although experientially a frequent occurrence, hematuria following post-prostatectomy radiation is not fully characterized. Turchan et al (page 1236) from Chicago, Illinois add to our understanding with a contemporary, single-institution study that describes in detail the long-term risks of hematuria and patient-reported urinary quality of life in men after salvage radiation.4 They show a relatively high incidence of hematuria, with only 55% of patients remaining free of a significant episode of hematuria, and 15% required some intervention. Unsurprisingly, they show a strong association between hematuria and radiation dose to the bladder as well as anticoagulation/antiplatelet therapy; however, the hematuria was generally self-limited and importantly the patient-reported urinary quality of life was not significantly impacted. Smoking Cessation and Bladder Cancer Recurrence Cigarette smoking is the single greatest preventable cause of disease in many jurisdictions, and after a cancer diagnosis, those who continue to smoke have a significant increase in adverse outcomes. Smoking cessation after a cancer diagnosis in some studies has been associated with improved outcomes such as reduced recurrence, perhaps reversing impaired DNA repair pathways and allowing some recovery of carcinogenesis defense mechanisms. Furberg at al (page 1200) from New York, New York add more detail to this discussion with a prospective study of 354 patients with bladder cancer and assessing biochemically verified post-diagnosis smoking exposure.5 In this cohort, most with higher risk nonmuscle-invasive bladder cancer, smoking exposure was detected in 22% of patients. After a median followup of 3.6 years, the authors were unable to detect any association between post-diagnosis smoking exposure and recurrence risk. Although the authors conclude that late smoking cessation, after the diagnosis of bladder cancer, may not substantially affect early disease recurrence, they stress that smoking cessation remains a critical component of bladder cancer care given the benefits beyond short-term recurrence rates.