- Email: [email protected]
MP81-19 PREDICTORS OF READMISSION FOLLOWING OPEN AND MINIMALLY INVASIVE SACRAL COLPOPEXY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE
THE JOURNAL OF UROLOGYâ
e1036
Vol. 193, No. 4S, Supplement, Tuesday, May 19, 2015
methods are not equivalent (with a pre-specified tolerance limit margin of 0.5 cm for equivalence with a common SD of 0.8 cm). The Mann-Whitney and Chi square tests were used for statistical analysis RESULTS: 121 patients have been randomized. 1 patient from the LS group and 1 from AS group were lost to f-up, 1 patient in the LS group was converted so finally we evaluated 58 pts in the LS arm and 60 in the AS arm. The median follow-up was 32,53 months (range 16e56 months). Operating time was longer for LS (mean 121 min for AS vs 219 min for LS, p<0.001). Intra-operative blood loss was higher in AS (mean 245 ml for AS vs 99,13 ml for LS, p<0.001) and hospital stays were longer (mean 5.8 days for AS vs 4.4 days for LS, p<0.001). The complications according to the Clavien-Dindo classification were 14 in the AS arm and 13 in the LS arm for the grade I (p¼ 0,15), 11 in the AS group Vs 1 in the LS group for the grade II (p¼0,02) and 1 in the AS group Vs 4 in the LS group for the grade III (p¼0,017). Tab I shows the mean post- operative point C/D evaluation for both techniques. No apical prolapse in both groups recurred, asymptomatic stage IeII recurrence was reported in 10% in AS vs 24.1% in LS (p¼0.051) CONCLUSIONS: These data show LS provide outcomes as good as AS with decreased morbidity, less blood loss and shorter recovery times. Recurrency in anterior and posterior compartment POP showed a difference in the two groups which, although not statistically significant, need to be evaluated in the long-term Type
C/D pre
C/D post
p
AS
-1,9
-7,4
<0.001
LS
-1,52
-7,36
<0.001
Total
-1,7
-7,38
<0.001
Source of Funding: none
MP81-19 PREDICTORS OF READMISSION FOLLOWING OPEN AND MINIMALLY INVASIVE SACRAL COLPOPEXY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE Ahmed Sarhan*, Ahmad Shabsigh, Ketul Shah, Columbus, OH INTRODUCTION AND OBJECTIVES: Post-operative readmissions have a significant impact on the health care cost. They reflect the quality of care and the complexity of our patients. Our objective is to define the rates and the predictors of unplanned readmissions following open (OSC) and minimally invasive sacral colpopexy (MISC). METHODS: We performed a retrospective review of prospectively collected database (NSQIP) of all patients who underwent open and minimally invasive sacral colpopexy between 2005 and 2012. Patient’s demographics, unplanned readmission rate and its causes were reported. Multivariate analysis was performed to characterize predictors of readmission. RESULTS: Between 2005 and 2012, a total of 1520 cases were identified. Data regarding readmission rates and possible causes of readmission was available for 2011 and 2012 dataset. Between 2011 and 2012, 1049 underwent sacral colpopexy. 386 patients (36.8%) underwent open sacral colpopexy (OSC) while 663 patients (63.2%) were managed through minimally invasive sacral colpopexy (MISC). Unplanned readmission and reoperation rates were comparable between the two groups (2.3% vs. 3.3%, P¼ 0.24 and 1.6% vs. 1.8%, P¼ 0.49 respectively). For both groups, postoperative ileus was the most common causes of readmission but it was significantly higher in OSC group accounting for 44.4% of total readmissions in OSC and 9.1% for MISC group (P¼ 0.043), other common causes for readmission in OSC group were surgical site infection (11.1 %) and pulmonary embolism (11.1 %). For MISC, other common causes of readmission were postoperative fever (9 %) and unspecified abdominal pain (4.5%). %). Logistic regression analysis was performed to define the predictors of readmission. For OSC, preoperative blood urea nitrogen (BUN) was the
only significant predictor for OSC (OR 1.4, 95% CI 1.05-1.87, P¼ 0.02) while for MISC preoperative serum albumin was the only significant predictor (OR 0.17, 95% CI 0.04-0.67, P¼ 0.012) and hypertension was near significant predictor (OR 4.5, 95% CI 0.86-23.87, P¼0.75). CONCLUSIONS: Both OSC and MISC have comparable readmission and reoperation rates. Predictors of readmission vary between different treatment options and selection of approach should be based on general condition as well as local factors. Source of Funding: none
MP81-20 THE LONG-TERM SAFETY, TRENDS AND RE-INTERVENTIONS IN THE SURGICAL MANAGEMENT OF STRESS URINARY INCONTINENCE Bilal Chughtai, Adrien Bernstein*, Jessica Buck, Jialin Mao, Abby Isaacs, Richard Lee, Alexis Te, Steven Kaplan, Art Sedrakyan, New York, NY INTRODUCTION AND OBJECTIVES: Stress urinary incontinence (SUI) can greatly decrease a women’s quality of life, and prevalence reports vary greatly indicating that up to 35% of women suffer from this condition. We determined short-term safety and long-term reinterventions following surgical treatment of stress urinary incontinence among female Medicare beneficiaries. METHODS: We analyzed a 5% national random sample of Medicare claims from 2000 to 2011 of female beneficiaries who underwent sling or bulking procedures, based on CPT-4 and ICD-9 procedure codes. Individual patient’s first sling or bulking procedure in the claim was identified. 90-day adverse events and re-interventions during the followup period were captured using ICD-9 diagnosis, procedure and CPT-4 codes. Statistical analysis for categorical data was performed to determine differences in distribution of patient demographics and comorbidities. Outcomes including 90-day adverse events and re-interventions were compared between treatment groups. Time to event was used to determine freedom from re-intervention after therapy. RESULTS: We identified 21,134 and 3,475 patients undergoing sling and bulking procedures between 2000 and 2011. There was a 29.7% increase in sling procedures and 59.5% decrease in bulking procedures from 2000 to 2011. 90-day adverse events of both procedures were rare, with exception of mild risk of urinary retention (Sling 11.3%, Bulk 8.4%). Smaller proportion of patients receiving slings had re-interventions compared to those who had bulking therapy. 53.2% sling patients and 76.3% bulking patients who had subsequent procedures received same procedure at first re-intervention. CONCLUSIONS: Both sling and bulking procedures are safe in terms of short-term performance. Patients who received initial treatment of bulking agent injection are more likely to have re-interventions. Patients who had re-interventions tend to repeat the therapy instead of converting to another procedure.
Source of Funding: None
e1036
Vol. 193, No. 4S, Supplement, Tuesday, May 19, 2015
methods are not equivalent (with a pre-specified tolerance limit margin of 0.5 cm for equivalence with a common SD of 0.8 cm). The Mann-Whitney and Chi square tests were used for statistical analysis RESULTS: 121 patients have been randomized. 1 patient from the LS group and 1 from AS group were lost to f-up, 1 patient in the LS group was converted so finally we evaluated 58 pts in the LS arm and 60 in the AS arm. The median follow-up was 32,53 months (range 16e56 months). Operating time was longer for LS (mean 121 min for AS vs 219 min for LS, p<0.001). Intra-operative blood loss was higher in AS (mean 245 ml for AS vs 99,13 ml for LS, p<0.001) and hospital stays were longer (mean 5.8 days for AS vs 4.4 days for LS, p<0.001). The complications according to the Clavien-Dindo classification were 14 in the AS arm and 13 in the LS arm for the grade I (p¼ 0,15), 11 in the AS group Vs 1 in the LS group for the grade II (p¼0,02) and 1 in the AS group Vs 4 in the LS group for the grade III (p¼0,017). Tab I shows the mean post- operative point C/D evaluation for both techniques. No apical prolapse in both groups recurred, asymptomatic stage IeII recurrence was reported in 10% in AS vs 24.1% in LS (p¼0.051) CONCLUSIONS: These data show LS provide outcomes as good as AS with decreased morbidity, less blood loss and shorter recovery times. Recurrency in anterior and posterior compartment POP showed a difference in the two groups which, although not statistically significant, need to be evaluated in the long-term Type
C/D pre
C/D post
p
AS
-1,9
-7,4
<0.001
LS
-1,52
-7,36
<0.001
Total
-1,7
-7,38
<0.001
Source of Funding: none
MP81-19 PREDICTORS OF READMISSION FOLLOWING OPEN AND MINIMALLY INVASIVE SACRAL COLPOPEXY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE Ahmed Sarhan*, Ahmad Shabsigh, Ketul Shah, Columbus, OH INTRODUCTION AND OBJECTIVES: Post-operative readmissions have a significant impact on the health care cost. They reflect the quality of care and the complexity of our patients. Our objective is to define the rates and the predictors of unplanned readmissions following open (OSC) and minimally invasive sacral colpopexy (MISC). METHODS: We performed a retrospective review of prospectively collected database (NSQIP) of all patients who underwent open and minimally invasive sacral colpopexy between 2005 and 2012. Patient’s demographics, unplanned readmission rate and its causes were reported. Multivariate analysis was performed to characterize predictors of readmission. RESULTS: Between 2005 and 2012, a total of 1520 cases were identified. Data regarding readmission rates and possible causes of readmission was available for 2011 and 2012 dataset. Between 2011 and 2012, 1049 underwent sacral colpopexy. 386 patients (36.8%) underwent open sacral colpopexy (OSC) while 663 patients (63.2%) were managed through minimally invasive sacral colpopexy (MISC). Unplanned readmission and reoperation rates were comparable between the two groups (2.3% vs. 3.3%, P¼ 0.24 and 1.6% vs. 1.8%, P¼ 0.49 respectively). For both groups, postoperative ileus was the most common causes of readmission but it was significantly higher in OSC group accounting for 44.4% of total readmissions in OSC and 9.1% for MISC group (P¼ 0.043), other common causes for readmission in OSC group were surgical site infection (11.1 %) and pulmonary embolism (11.1 %). For MISC, other common causes of readmission were postoperative fever (9 %) and unspecified abdominal pain (4.5%). %). Logistic regression analysis was performed to define the predictors of readmission. For OSC, preoperative blood urea nitrogen (BUN) was the
only significant predictor for OSC (OR 1.4, 95% CI 1.05-1.87, P¼ 0.02) while for MISC preoperative serum albumin was the only significant predictor (OR 0.17, 95% CI 0.04-0.67, P¼ 0.012) and hypertension was near significant predictor (OR 4.5, 95% CI 0.86-23.87, P¼0.75). CONCLUSIONS: Both OSC and MISC have comparable readmission and reoperation rates. Predictors of readmission vary between different treatment options and selection of approach should be based on general condition as well as local factors. Source of Funding: none
MP81-20 THE LONG-TERM SAFETY, TRENDS AND RE-INTERVENTIONS IN THE SURGICAL MANAGEMENT OF STRESS URINARY INCONTINENCE Bilal Chughtai, Adrien Bernstein*, Jessica Buck, Jialin Mao, Abby Isaacs, Richard Lee, Alexis Te, Steven Kaplan, Art Sedrakyan, New York, NY INTRODUCTION AND OBJECTIVES: Stress urinary incontinence (SUI) can greatly decrease a women’s quality of life, and prevalence reports vary greatly indicating that up to 35% of women suffer from this condition. We determined short-term safety and long-term reinterventions following surgical treatment of stress urinary incontinence among female Medicare beneficiaries. METHODS: We analyzed a 5% national random sample of Medicare claims from 2000 to 2011 of female beneficiaries who underwent sling or bulking procedures, based on CPT-4 and ICD-9 procedure codes. Individual patient’s first sling or bulking procedure in the claim was identified. 90-day adverse events and re-interventions during the followup period were captured using ICD-9 diagnosis, procedure and CPT-4 codes. Statistical analysis for categorical data was performed to determine differences in distribution of patient demographics and comorbidities. Outcomes including 90-day adverse events and re-interventions were compared between treatment groups. Time to event was used to determine freedom from re-intervention after therapy. RESULTS: We identified 21,134 and 3,475 patients undergoing sling and bulking procedures between 2000 and 2011. There was a 29.7% increase in sling procedures and 59.5% decrease in bulking procedures from 2000 to 2011. 90-day adverse events of both procedures were rare, with exception of mild risk of urinary retention (Sling 11.3%, Bulk 8.4%). Smaller proportion of patients receiving slings had re-interventions compared to those who had bulking therapy. 53.2% sling patients and 76.3% bulking patients who had subsequent procedures received same procedure at first re-intervention. CONCLUSIONS: Both sling and bulking procedures are safe in terms of short-term performance. Patients who received initial treatment of bulking agent injection are more likely to have re-interventions. Patients who had re-interventions tend to repeat the therapy instead of converting to another procedure.
Source of Funding: None