Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of factors and short-term postoperative morbidity associated with early versus late discharge following urethroplasty

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To determine factors associated with early (same-day) versus late (> 1 day) discharge of male patients following urethroplasty, and to compare short-term (30-day) postoperative morbidity and mortality across the two groups.

Methods

Using the National Surgical Quality Improvement Program database (2005–2016), patients who underwent urethroplasty with same-day hospital discharge (early) and those who stayed > 1 day (late) were identified. Extracted data included patient characteristics, comorbidities, preoperative labs, and 30-day postoperative complications. Multivariable logistic regressions determined factors associated with early (vs. late) discharge and the likelihood of having a complication in those who were discharged early (vs. late). Adjusted odds ratios and 95% CIs were reported.

Results

N = 1435 male urethroplasty patients were identified, of which 396 (27.6%) were discharged early and 1039 (72.4%) were discharged late. White race (OR [95% CI]: 2.21 [1.44, 3.38]), urethroplasty performed in/after year 2011 (4.23 [2.51, 7.15]), and anterior (vs. posterior) urethroplasty without tissue transfer (1.65 [1.17, 2.34]) were significantly associated with increased likelihood of early discharge. However, every 10-min increase in operation time (0.88 [0.86, 0.90]) decreased the odds of early discharge. When short-term postoperative complications were compared between the two groups, patients discharged early had a lower likelihood of being readmitted (0.35 [0.14, 0.88]) compared to those discharged late. Rates of mortality, complications, or reoperation were similar between the groups.

Conclusions

Predictors of early discharge following urethroplasty include shorter operating time, white race, and having an anterior (vs. posterior) urethroplasty without tissue transfer. Patients discharged early had a lower likelihood of being readmitted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

ACS-NSQIP:

American College of Surgeons National Surgical Quality Improvement Program

aOR:

Adjusted odds ratio

ASA:

American Society of Anesthesiologists

CPT:

Current procedural terminology

LOS:

Length of stay

OPTIME:

Operating time

OR:

Operating room

WBC:

White blood cell

References

  1. Hampson LA, McAninch JW, Breyer BN (2014) Male urethral strictures and their management. Nat Rev Urol 11(1):43–50. https://doi.org/10.1038/nrurol.2013.275

    Article  PubMed  Google Scholar 

  2. Santucci RA, Joyce GF, Wise M (2007) Male urethral stricture disease. J Urol 177(5):1667–1674. https://doi.org/10.1016/j.juro.2007.01.041

    Article  PubMed  Google Scholar 

  3. Lazzeri M, Sansalone S, Guazzoni G, Barbagli G (2016) Incidence, causes, and complications of urethral stricture disease. Eur Urol Suppl 15(1):2–6. https://doi.org/10.1016/j.eursup.2015.10.002

    Article  Google Scholar 

  4. Peterson A (2019) Urethral strictures in men. https://www-uptodate-com.libproxy.uams.edu/contents/urethral-strictures-in-men?search=urethroplasty&source=search_result&selectedTitle=1~14&usage_type=default&display_rank=1. UpToDate 2019

  5. Jordan G, Chapple C, Heyns C (eds) (2010) Urethral strictures: an international consultation on urethral strictures. Societe Internationale d'Urologie, Montreal

    Google Scholar 

  6. Liberman D, Pagliara TJ, Pisansky A, Elliott SP (2015) Evaluation of the outcomes after posterior urethroplasty. Arab J Urol 13(1):53–56. https://doi.org/10.1016/j.aju.2015.02.002

    Article  PubMed  PubMed Central  Google Scholar 

  7. MacDonald S, Haddad D, Choi A, Colaco M, Terlecki R (2017) Anterior urethroplasty has transitioned to an outpatient procedure without serious rise in complications: data from the national surgical quality improvement program. Urology 102:225–228. https://doi.org/10.1016/j.urology.2016.09.043

    Article  PubMed  Google Scholar 

  8. Mandal A, Imran D, McKinnell T, Rao GS (2005) Unplanned admissions following ambulatory plastic surgery—a retrospective study. Ann R Coll Surg Engl 87(6):466–468. https://doi.org/10.1308/003588405X60560

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Lewis JB, Wolgast KA, Ward JA, Morey AF (2002) Outpatient anterior urethroplasty: outcome analysis and patient selection criteria. J Urol 168(3):1024–1026. https://doi.org/10.1097/01.ju.0000025400.77578.72

    Article  PubMed  Google Scholar 

  10. Okafor H, Nikolavsky D (2015) Impact of short-stay urethroplasty on health-related quality of life and patient’s perception of timing of discharge. Adv Urol 2015:806357. https://doi.org/10.1155/2015/806357

    Article  PubMed  PubMed Central  Google Scholar 

  11. American College of Surgeons (2019) ACS National Surgical Quality Improvement Program. American College of Surgeons. https://www.facs.org/quality-programs/acs-nsqip. Accessed 1 Sept 2019

  12. Shiloach M, Frencher SK, Steeger JE, Rowell KS, Bartzokis K, Tomeh MG, Richards KE, Ko CY, Hall BL (2010) Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 210(1):6–16. https://doi.org/10.1016/j.jamcollsurg.2009.09.031

    Article  PubMed  Google Scholar 

  13. Davenport DL, Henderson WG, Khuri SF, Mentzer RM Jr (2005) Preoperative risk factors and surgical complexity are more predictive of costs than postoperative complications: a case study using the National Surgical Quality Improvement Program (NSQIP) database. Ann Surg 242(4):463–468. https://doi.org/10.1097/01.sla.0000183348.15117.ab(discussion 468-471)

    Article  PubMed  PubMed Central  Google Scholar 

  14. Khuri SF (2005) The NSQIP: a new frontier in surgery. Surgery 138(5):837–843. https://doi.org/10.1016/j.surg.2005.08.016

    Article  PubMed  Google Scholar 

  15. Lacy JM, Madden-Fuentes RJ, Dugan A, Peterson AC, Gupta S (2018) Short-term complication rates following anterior urethroplasty: an analysis of national surgical quality improvement program data. Urology 111:197–202. https://doi.org/10.1016/j.urology.2017.08.006

    Article  PubMed  Google Scholar 

  16. Blaschko SD, Harris CR, Zaid UB, Gaither T, Chu C, Alwaal A, McAninch JW, McCulloch CE, Breyer BN (2015) Trends, utilization, and immediate perioperative complications of urethroplasty in the United States: data from the national inpatient sample 2000–2010. Urology 85(5):1190–1194. https://doi.org/10.1016/j.urology.2015.01.008

    Article  PubMed  PubMed Central  Google Scholar 

  17. Haider AH, Scott VK, Rehman KA, Velopulos C, Bentley JM, Cornwell EE, Al-Refaie W (2013) Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors. J Am Coll Surg 216(3):482–492.e412. https://doi.org/10.1016/j.jamcollsurg.2012.11.014

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kominski GF, Nonzee NJ, Sorensen A (2017) The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annu Rev Public Health 38:489–505. https://doi.org/10.1146/annurev-publhealth-031816-044555

    Article  PubMed  Google Scholar 

  19. Santucci RA (2014) The reconstructive urology work force: present and future. Transl Androl Urol 3(2):205–208. https://doi.org/10.3978/j.issn.2223-4683.2014.04.08

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gomez RG, Scarberry K (2018) Anatomy and techniques in posterior urethroplasty. Transl Androl Urol 7(4):567–579. https://doi.org/10.21037/tau.2018.03.05

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham St., Little Rock, AR, USA

    Mahmoud I. Khalil, Scotty McKay, Mohamed H. Kamel, Rodney Davis & Ehab Eltahawy

  2. Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Naleen Raj Bhandari & Nalin Payakachat

  3. Department of Urology, Tulane University, New Orleans, LA, USA

    Omer A. Raheem

  4. Department of Urology, Ain Shams University, Cairo, Egypt

    Mahmoud I. Khalil, Mohamed H. Kamel, Ahmed Safaan & Ehab Eltahawy

Authors
  1. Mahmoud I. Khalil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naleen Raj Bhandari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scotty McKay
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed H. Kamel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ahmed Safaan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rodney Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nalin Payakachat
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Omer A. Raheem
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ehab Eltahawy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ehab Eltahawy.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest except for the co-author (NRB) who was a PhD candidate at University of Arkansas for Medical Sciences when this study was conducted. He is currently employed by Eli Lilly and Company.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

See Table

Table 4 Description of CPT codes that were used for identification of tissue transfer (flaps/grafts)
Full size table

4.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khalil, M.I., Bhandari, N.R., McKay, S. et al. Evaluation of factors and short-term postoperative morbidity associated with early versus late discharge following urethroplasty. Int Urol Nephrol 52, 1279–1286 (2020). https://doi.org/10.1007/s11255-020-02410-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-020-02410-4

Keywords

Search

Navigation