Tae Kim

MP92-07 TAKE ‘NOTES’: IDENTIFYING DRIVERS OF 30 DAY READMISSION AFTER RADICAL PROSTATECTOMY

knowledge of the key variables. Our study aimed to utilize the International robotic cystectomy consortium (IRCC) database of robotassisted radical cystectomy (RARC) to determine patient and institutional variables of importance in scheduling the procedure. METHODS: 2686 RARCs performed at 23 institutions from 12 countries were utilized from the IRCC database. Variables used for prediction of surgical times were: institutional RARC volume, age at RARC, gender, BMI, ASA Score, history of prior abdominal surgery and radiation, clinical stage of disease, administration of neoadjuvant chemotherapy, approach, and type of diversion. A conditional inference tree method was used to fit a binary decision tree predicting operative time. Permutation tests were performed to determine the variables having the strongest association with RARC surgical time. The data was split at the value of this variable resulting in the largest difference in means for the surgical time across the split. This process was repeated separately on the resultant data sets until the permutation tests showed no significant association. RESULTS: 2136 procedures were included in the analysis. The most important determinant of surgical time was the type of diversion (Ileal conduits 69 minutes shorter than Neobladders, p<0.001). Among patients who received neobladders, BMI was also an important determinant of surgical time (higher BMIelonger by 50 minutes, p<0.001). Among the Ileal conduit patients, institutional RARC volume was an important factor (44 minutes, p<0.001). In the following regression tree, the box plots show the median, interquartile deviation, and ranges of surgical times for each node. CONCLUSIONS: We developed a methodology to predict operative time for RARC based on patient, disease characteristics and Institutional experience. This model can be used to improve OR efficiency.

PD58-07 MUSIC OCTAVE – COMPOSITE MEASURES TO ASSESS SURGEON PERFORMANCE FOR ROBOTIC PROSTATECTOMY

evaluated the type and quantity of opioids prescribed, standardized to morphine milligram equivalents (MME). Finally, we quantified surgeonspecific variation in MMEs prescribed for surgeons with 10 or more patients in the cohort, and at least 5 filling an opioid prescription postoperatively. RESULTS: We identified 25,102 men who received a vasectomy during the study interval. Among this group, 10,442 (41.6%) patients filled an opioid prescription after surgery. Hydrocodone was the most common medication, comprising 66.7% of filled prescriptions. The median number of MMEs prescribed was 112.5 [IQR 82.5-150]; equivalent to twenty-three, 5 mg hydrocodone tablets per prescription [IQR 16.5-30 tablets/ prescription]. Across 360 surgeons meeting criteria for surgeon-specific analysis, the average number of MMEs prescribed after vasectomy varied substantially (range: 29.2-390 MMEs (p<0.001); corresponding to a range of six to seventy-eight, 5 mg hydrocodone tablets per prescription (Figure). CONCLUSIONS: Less than half of men fill an opioid prescription following vasectomy, indicating that non-opioid pain strategies may be sufficient for most patients. Nonetheless, surgeon-specific analyses revealed a 13-fold difference in the average quantity of opioids supplied. Because patient necessity is unlikely to entirely explain this variability, efforts to reduce excess opioid prescribing after vasectomy are warranted.

PD58-06 SURGICAL SKILL AND PATIENT OUTCOMES AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY

evaluated the type and quantity of opioids prescribed, standardized to morphine milligram equivalents (MME). Finally, we quantified surgeonspecific variation in MMEs prescribed for surgeons with 10 or more patients in the cohort, and at least 5 filling an opioid prescription postoperatively. RESULTS: We identified 25,102 men who received a vasectomy during the study interval. Among this group, 10,442 (41.6%) patients filled an opioid prescription after surgery. Hydrocodone was the most common medication, comprising 66.7% of filled prescriptions. The median number of MMEs prescribed was 112.5 [IQR 82.5-150]; equivalent to twenty-three, 5 mg hydrocodone tablets per prescription [IQR 16.5-30 tablets/ prescription]. Across 360 surgeons meeting criteria for surgeon-specific analysis, the average number of MMEs prescribed after vasectomy varied substantially (range: 29.2-390 MMEs (p<0.001); corresponding to a range of six to seventy-eight, 5 mg hydrocodone tablets per prescription (Figure). CONCLUSIONS: Less than half of men fill an opioid prescription following vasectomy, indicating that non-opioid pain strategies may be sufficient for most patients. Nonetheless, surgeon-specific analyses revealed a 13-fold difference in the average quantity of opioids supplied. Because patient necessity is unlikely to entirely explain this variability, efforts to reduce excess opioid prescribing after vasectomy are warranted.

MP96-15 SURGICAL PROCEDURAL VOLUME MAY NOT BE SOLE DRIVER OF URINARY FUNCTION OUTCOME FOLLOWING RADICAL PROSTATECTOMY

INTRODUCTION AND OBJECTIVES: Hospital acquired conditions are a significant source of patient morbidity and mortality and have been targeted by recent legislation as achievable target for quality improvement. Here, we aim to define the rates of 3 most of the most common hospital acquired conditions (HACs); surgical site infection (SSI) , urinary tract infection (UTI) , and venous thromboembolism (VTE) in patients who undergo major urologic surgery over a period of time encompassing the implementation of the Hospital Acquired Condition Reduction program. 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/robotic). Multivariable logistic regression was used to determine the association between [insert independent variable of interest] and HACs. RESULTS: We identified 39,257 patients undergoing major urologic surgery, of whom 2300 (5.8%) had at least one hospital acquired condition. UTI (2.58%) was the most common, followed by SSI (2.46%) and VTE (0.68%). Multivariable logistic regression analysis demonstrated that open surgical approach, diabetes, obesity, hypertension, congestive heart failure, BMI>30, and length of stay were associated with higher likelihood of HAC. When controlling for surgical approach, patients undergoing prostatectomy had the lowest predicted probability of HAC (PP 0.04, p<0.05) compared to patients undergoing upper tract surgery (PP 0.06) or cystectomy and retroperitoneal lymph node dissection (PP 0.02) We observed a non-significant secular trend of decreasing rates of HAC from 7.4% to 5.8% HAC’s during the study period, which encompassed the implementation of the CMS Hospital Acquired Condition Reduction Program. CONCLUSIONS: HACs occurred at a rate of 5.8% during 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 nonmodifiable factors associated with HACs is critical in developing effective reduction programs.