To characterize the safety and practice patterns of artificial urinary sphincter (AUS) placement on a population level. Increasingly artificial urinary sphincter (AUS) implantation has shifted to be an outpatient surgery; however, there is a lack of large-scale research evaluating factors associated with early (≤24 hours) versus late (>24 hours) discharges and complications in men following AUS placement. We utilized the National Surgical Quality Improvement Program (NSQIP) database to identify and compare factors and outcomes associated with each approach.
NSQIP database was queried for men undergoing AUS placement between 2007-2016. Patients were classified as either early discharge (ED, ≤24 hours) and late discharge (LD, >24 hours). Baseline demographics, operating time, and complications were compared between the two groups. Multivariate logistic regression evaluated factors associated with discharge timing and 30-day complications.
A total of 1,176 patients were identified and were classified as ED in 232 and LD in 944 patients. Operative time was shorter in ED (83 minutes) compared to LD (95 minutes, p<0.001). Hypertension was more prevalent among LD patients (60.3% vs 69.1% for ED and LD respectively, p<0.001). The 30-day complication rate was similar in both groups (ED: 4.3% vs LD: 3.4%, p=0.498). Multivariable analysis revealed that surgery after 2012 was associated with ED (OR=3.66, p<0.001).
At the national level, there are no differences in postoperative morbidity between early and late discharges. There is a trend towards more ED, specifically after 2012. A prospective study on the feasibility and safety of outpatient AUS is needed.
Urology. 2020 Oct 16 [Epub ahead of print]
Thomas M Shelton, Scott C Brimley, Hoang Minh Tue Nguyen, Igor Voznesensky, Mahmoud I Khalil, Bruno Machado, Naleen Raj Bhandari, Nalin Payakachat, Rodney Davis, Mohamed H Kamel, Omer A Raheem, Cooper Benson
Department of Urology, Tulane University, New Orleans, Louisiana., Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas., Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas., Department of Urology, Tulane University, New Orleans, Louisiana. Electronic address: .