Adverse events and readmissions after day-case urological surgery (original) (raw)
Related papers
Predictors of Readmission following Outpatient Urological Surgery
The Journal of Urology, 2014
The Patient Protection and Affordable Care Act increases oversight of surgical outcomes and ties hospital readmissions to Medicare reimbursement. Given the increasing volume of outpatient urological procedures, to our knowledge this study provides the first multi-institutional multivariate analysis of patient factors that contribute to readmission. Using the 2011 National Surgical Quality Improvement Program database we identified 7,795 patients. Multiple logistic regression was used to predict 30-day unplanned hospital readmissions controlling for demographics, clinical characteristics and comorbidities. Readmission rates of the 5 most common procedures were calculated along with the rate of postoperative complications associated with readmission. Outpatient urological surgery had an overall 3.7% readmission rate. The 5 most common procedures were cystourethroscopy and resection of bladder tumor (readmission rate 4.97%), laser prostatectomy (4.27%), transurethral resection of prostate (4.24%), hydrocele excision (1.92%) and sling surgery for urinary incontinence (0.85%). The most common comorbidities in readmitted patients were hypertension, diabetes and smoking. Risk adjusted multiple regression indicated that cancer history (OR 3.48), bleeding disorder (OR 2.03), male gender (OR 1.38), ASA(®) level 3 or 4 (OR 1.34) and age (OR 1.01) were significant predictors of readmission. Readmitted patients also had a higher 30-day complication rate. Readmission after outpatient urological surgery occurs at a rate of 3.7%. A history of cancer, bleeding disorder, male gender, ASA level 3 or 4 and age were associated with readmission along with greater rates of medical and surgical complications. Our results may help guide risk reduction initiatives and prevent costly readmissions.
Enhanced Recovery After Surgery Protocols in Major Urologic Surgery
Frontiers in Medicine
The purpose of the review: The analysis of the components of enhanced recovery after surgery (ERAS) protocols in urologic surgery. Recent findings: ERAS protocols has been studied for over 20 years in different surgical procedures, mostly in colorectal surgery. The concept of improving patient care and reducing postoperative complications was also applied to major urologic surgery and especially procedure of radical cystectomy. This procedure is technically challenging, due to a major surgical resection and high postoperative complication rate that may reach 65%. Several clinical pathways were introduced to improve perioperative course and reduce the length of hospital stay. These protocols differ from ERAS modalities in other surgeries. The reasons for this are longer operative time, increased risk of perioperative transfusion and infection, and urinary diversion achieved using transposed intestinal segments. Previous studies in this area analyzed the need for mechanical bowel preparation, postoperative nasogastric tube decompression, as well as the duration of urinary drainage. Furthermore, the attention has also been drawn to perioperative fluid optimization, pain management, and bowel function. Summary: Notwithstanding partial resemblance between the pathways in major urologic surgery and other pelvic surgeries, there are still scarce guidelines for ERAS protocols in urology, which is why further studies should assess the importance of preoperative medical optimization, implementation of thoracic epidural anesthesia and analgesia, and perioperative nutritional management.
Journal of anesthesia and surgery, 2019
Background: Individual surgeon and institutional performance are usually assessed by morbidity and mortality rates, which can be calculated using peri-operative metrics, such as POSSUM (Physiological and Operative Severity Score for the enUmeration of mortality and morbidity). Post-operative risk can be estimated using the surgical Apgar outcome score. However, pre-operative co-morbidity may contribute to case risk diversity and affect immediate peri-operative metrics and short-and long-term morbidity and mortality. We estimated the correlation between pre-operative co-morbidity or risk assessment indices and peri-operative metrics in urological patients. Material and Methods: The study included 100 consecutive patients (80.8% males, mean age ± SD 66.3 ± 10.7 years, range 30-88 years) undergoing major open urological procedures (39 nephrectomies, 43 radical prostatectomies, 18 radical cystectomies). Pre-operative co-morbidity was assessed using Charlson Comorbidity Index (CCI), age-adjusted CCI (AA-CCI), Cumulative Illness Rating Scale (CIRS), and Index of Co-Existent Diseases (ICED). Pre-operative risk was assessed with the American Society of Anesthesiologists index (ASA). Functional status was quantified based on estimation of the metabolic equivalent (MET). Peri-operative metrics included POSSUM and surgical Apgar scores. Results: All pre-operative indices significantly correlated with POSSUM, but none correlated with the surgical Apgar score. Conclusions: In patients undergoing major open urological procedures, risk stratification in the post-operative setting using the surgical Apgar score is independent of pre-operative co-morbidity status. In contrast, pre-operative co-morbidity and risk assessment correlated with peri-operative metrics used to calculate morbidity and mortality risk. Reports of death and complication rates do not take into account case diversity and, therefore, should be adjusted for co-morbidity status.
Indications for surgical intensive care unit admission of postoperative urologic patients
Urology, 2000
To analyze the practice of surgical intensive care unit (SICU) admission of postoperative urologic patients and to define objective criteria to predict active treatment requirements and length of stay in the SICU. The records of 90 consecutive patients admitted to the SICU postoperatively in the 12-month period from January 1996 to December 1996 were retrospectively reviewed. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score was calculated from patient parameters acquired within the first 12 hours. The correlation of outcome variables to the length of stay and the requirements for active treatment in the SICU were analyzed and used to develop a risk stratification model. This algorithm was subsequently validated on a population of 46 patients who underwent radical cystectomy the following year. Only the preoperative American Society of Anesthesia class, the event of an intraoperative complication, and the APACHE II score were statistically significant (P <0.05) predictors of length of stay and active treatment. The patients were subsequently categorized into high and low-risk groups, which were found to have mean SICU stays of 39.9 +/- 3.92 hours and 20.2 +/- 0.45 hours, respectively (P = 0. 001), and an active SICU-specific treatment rate of 58.0% and 14.3%, respectively (P = 0.001). These results were confirmed in the validation population. Postoperative risk stratification may be helpful in predicting SICU requirements in the immediate postoperative period and in identifying patients at lower or higher risk of an adverse outcome.
Appropriateness of Length of Hospital Stay for Patients Undergoing One-Day Urology Surgery
One day surgery has developed over the past 3 decades for a number of reasons including advanced managing care and health maintenance organizations, improved surgical instruments, less invasive surgical techniques, availability of a team approach in preparing a person for surgery and home recovery and the desire to reduce health care costs. The present study aimed at assessing the Pre-decided one day surgeries among patients admitted in urology surgery department at the Main University Hospital, determining proportion of inappropriate days of hospitalization, and uncovering reasons associated with inappropriate utilization of hospital stay. Among 1607 reviewed records, 800 (49.78%) cases were decided to be conducted as one-day surgeries. Concerning the total Length of Stay (LOS), findings revealed that only 10.6% of these days were appropriate 89.4% of the reviewed hospital days were inappropriate and can be managed for more efficient and effective care provision. Premature admission, weekends and problems in scheduling surgery were the reasons of inappropriate preoperative stay, while doing diagnostic procedures and/or treatment that can be done on an outpatient basis and lack of family for home care, were found to be reasons for postoperative stay.
Optimizing Outcomes in Urologic Surgery: Intraoperative Considerations
2018
Introduction Surgical outcomes vary based on patientand disease-related characteristics as well as institutional, technological, equipment, and human factors. Some factors linked to poor outcomes (e.g., difficult anatomy) cannot be improved prior to surgery. However, there are many factors linked to surgical outcomes that can be modified by either surgeons, surgical teams, or healthcare institutions. This white paper is the second in a three-part series describing such factors and potential intervention strategies that might be useful to optimize the outcomes of surgical patients. It is important to note that this is not a “guideline,” as the strength of evidence linking interventions to patient outcome varies widely. Where guidelines on specific topics are available, links have been provided. Since this resource summarizes a large range of topics, additional details can be found in the hyperlinks and references provided. Of note, “intraoperative” is herein arbitrarily defined as th...
Journal of Endourology, 2014
Objective: To explore the relationship between operative time, approach, and length of stay (LOS) in partial nephrectomy (PN), radical prostatectomy (RP), and adrenalectomy (AD). Materials and Methods: Using the National Surgical Quality Improvement Program database, we identified all PN, RP, and AD from 2010 to 2012. Non-prostate cancer RP were excluded. The primary outcome was LOS. Descriptive comparisons were drawn between open and minimally invasive surgery (MIS) for each surgery. Multiple linear regression assessed the impact of open versus MIS and operative time on LOS when controlling for confounders. Results: We identified 3760 PN (60% MIS), 12,081 RP (82% MIS), and 1684 AD (76% MIS) cases for inclusion. Differences in operative time were identified. In PN and RP, MIS mean operative time was 10 to 23 minutes longer ( p < 0.001 each); while for AD, open was 35 minutes longer ( p < 0.001). Open procedures had consistently longer median LOS ( p < 0.001 all). Results of the linear regression are given next. Conclusions: Operative time and surgical approach are directly associated with LOS, independent of complications and patient comorbidities.