Devin Haddad

Short-term complications associated with the use of transvaginal mesh in pelvic floor reconstructive surgery: Results from a multi-institutional prospectively maintained dataset

Vaginal reconstructive surgery can be performed with or without mesh. We sought to determine comparative rates of perioperative complications of native tissue versus vaginal mesh repairs for pelvic organ prolapse.

NSQIP indexed complications following TURBT and contemporary financial implications.

Introduction: We determined the incidence of NSQIP (National Surgical Quality Improvement Project) indexed complications by tumor size and investigated the related financial implications based on contemporary reimbursement schedules. Methods: Transurethral bladder tumor resection procedures performed from 2010 to 2012 were identified and stratified by size specific CPT coding. Preoperative characteristics, surgical parameters and 30‐day perioperative outcomes were compared using chi‐square analysis and Student’s t‐test. Financial data for all inpatient transurethral bladder tumor resections performed during the most recent fiscal year at our institution were collected and analyzed, and a comparison was made using up‐to‐date Medicare reimbursement schedules. Results: We identified 8,116 cases, including 3,533 coded as small (43.3%), 2,734 medium (33.5%) and 1,849 large (22.6%). Large resections required longer operative time (small—25.8 minutes, medium—33.0 minutes, large—49.0 minutes, p <0.01) and length of stay (small—0.67 days, medium—1.1 days, large—1.9 days, p <0.006), and had higher rates of transfusion (small—0.74%, medium—1.5%, large—3.7%, p <0.001), sepsis (small—0.23%, medium—0.44%, large—0.92%, p <0.05), renal insufficiency (small—0.17%, medium—0.15%, large—0.60%, p <0.01) and 30‐day mortality (small—0.2%, medium—1%, large—1.8%, p <0.05) independent of preoperative parameters. Large resections were also associated with higher rates of 30‐day readmission (small—4.3%, medium—6.3%, large—9.4%, p <0.001) and reoperation (small—2.1%, medium—2.7%, large—4.5%, p <0.001). Institutional data demonstrate that the most common Diagnosis Related Group classification results in an operating loss when treating Medicare beneficiaries. Conclusions: Urologist selected coding directly correlates with NSQIP indexed postoperative complications. Many cases of transurethral bladder tumor resection with associated complications may result in financial loss for the performing institutions. Efforts to improve quality of care and reimbursement seem warranted.

MP52-05 ANTERIOR URETHROPLASTY HAS TRANSITIONED TO AN OUTPATIENT PROCEDURE, BUT WITH INCREASED COMPLICATIONS: DATA FROM NSQIP

INTRODUCTION AND OBJECTIVES: Transitioning surgery from inpatient to outpatient management may potentially decrease cost. Anterior urethroplasty, which has traditionally been performed on an inpatient basis, can be performed as a same-day operation, but outcomes data is lacking. Our study sought to examine the trend in inpatient versus outpatient performance of single stage anterior urethroplasty and to determine outcomes using data from the National Surgical Quality Improvement Program (NSQIP) database. METHODS: A retrospective cross sectional analysis of NSQIP data was performed. Cases of single stage anterior urethroplasty were identified using the ICD-9 procedure code 53410. All cases reported between the years 2006-2013 were identified and postoperative complications were examined. Univariate analysis was performed to determine 30-day complication rates and associated risk factors for both inpatient and outpatient cases. A linear regression model was created for all years with greater than 50 reported cases. RESULTS: A total of 326 anterior urethroplasties were reported over the study period; 222 (68.1%) were performed as inpatient procedures, and 104 (31.9%) were performed on an outpatient basis. The linear regression model shows a significant decrease in inpatient procedures (R1⁄40.91) and a significant increase in outpatient procedures (R1⁄40.91) for the last 3 years of the study period. Mean length of stay following inpatient procedures was 1.8 days. The most common complication was urinary tract infection, which was consistent between inpatient (2.7%) and outpatient (2.9%) procedures. The rate of wound dehiscence, however, was significantly higher among outpatient cases (1.92% vs 0%, p 1⁄4 0.03), although the overall incidence was low. There were no significant differences in the rates of wound infection, bleeding, graft failure, deep vein thrombosis, pneumonia, or sepsis. Resident involvement in surgery was associated with a significantly decreased rate of reoperation (0% vs 9.1% p<0.001). CONCLUSIONS: : In recent years, there has been a significant shift in the performance of anterior urethroplasty toward outpatient management. Regardless of setting, the overall complication rates appear low, however outpatient management was associated with a significantly increased risk of wound dehiscence. Resident involvement was associated with a significantly reduced chance of reoperation. Future work is necessary to determine how to decrease overall cost of single stage urethroplasty without compromising quality of care.

MP3-09 COMPARISON OF SURGICAL OUTCOMES IN BENIGN PROSTATIC HYPERTROPHY MANAGEMENT USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM

p1⁄40.52) and IPSS (19 v 20 p1⁄40.38) was equivalent. Vaporization was associated with significant increase in operative time 81 15 minutes range 40e110 p <0.001), versus (mean 55 10 minutes range 30e70 minutes, less blood loss (0.8% compared to 2.0% drop in hemoglobin, p<0.001) but increased postoperative urinary frequency (80% vs 50% p <0.001), hematuria with clots as long as 4 weeks after surgery (20% vs 2%, p <0.001) and postoperative urethral stricture (11% vs 0%). Postoperatively, both techniques improved Qmax (17 cc/s vs 18 cc/s p1⁄40.22), postoperative prostate volume (32 vs 31 g p1⁄40.31) and IPSS (6 v 5 p1⁄40.22) equivalently CONCLUSIONS: Bipolar vaporization of the prostate, despite being a technically robust, speedy procedure with less intraoperative bleeding, appears to be associated with moderately increased postoperative irritative voiding symptoms, greatly increased late-onset postoperative bleeding as long as 4 weeks after surgery and unacceptably high urethral stricture rates. Use of this increasingly popular technique must measure these costs against its benefits.