Comparative evaluation of 90-day patient outcomes and healthcare encounters following extended day surgery urethroplasty.

Mark McAllister, Keith F Rourke, Nathan Hoy
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Abstract

Introduction: Most centers have shifted to an extended day surgery (XDS ) model for urethroplasty. Our study characterizes outcomes and unplanned healthcare encounters of patients undergoing XDS urethroplasty compared to case-matched inpatient controls.

Methods: We conducted a retrospective, two-surgeon, single-center study of patients undergoing XDS urethroplasty (discharge <24 hrs) from November 2020 to November 2021. Patients were case-control matched based on age, stricture length, location, and etiology to patients who had previously undergone inpatient urethroplasty. Data was analyzed using descriptive and univariable statistics. Multivariable analysis by Cox proportional hazard regression was used to identify associations with postoperative complications.

Results: Ninety patients (mean age=53.8 years) underwent XDS urethroplasty during the study period. Mean stricture length was 4.4 cm (standard deviation [SD ] 2.4). Rates of postoperative complications were similar between XDS (17%, n=15) and admitted patients (21%, n=19), and XDS was not associated with increased risk on univariable analysis (odds ratio [OR ] 0.65, 95% confidence interval [CI] 0.31-1.3, p=0.36). When stratifying by location, penile stricture (OR 4.21, 95% CI 1.3-13.8, p=0.02) and lichen sclerosus (OR 2.91, 95% CI 0.79-9.9, p=0.08) were associated with increased risk of postoperative complication. On multivariable analysis, only penile stricture was identified as significant (OR 4.78, 95% CI 1.2-19.4, p=0.03). Forty-eight percent (n=43) of patients had unplanned healthcare encounters postoperatively, with similar numbers of phone calls (n=37) and emergency department visits (n=36) between groups.

Conclusions: Our study shows that XDS urethroplasty is not associated with increased rates of complications relative to inpatient admission. This data supports using an XDS pathway for resource-efficient treatment of urethral strictures in a universal healthcare setting.

对延长日间手术尿道成形术后 90 天的患者疗效和医疗服务进行比较评估。
导言:大多数医疗中心已转向采用延长日间手术(XDS)模式进行尿道成形术。与病例匹配的住院病人对照组相比,我们的研究描述了接受 XDS 尿道成形术的病人的预后和意外医疗情况:我们对接受 XDS 尿道成形术的患者(出院结果)进行了一项回顾性、双外科医生、单中心研究:90名患者(平均年龄=53.8岁)在研究期间接受了XDS尿道成形术。平均狭窄长度为 4.4 厘米(标准差 [SD] 2.4)。XDS(17%,n=15)和入院患者(21%,n=19)的术后并发症发生率相似,单变量分析显示,XDS与风险增加无关(几率比[OR] 0.65,95% 置信区间[CI] 0.31-1.3,P=0.36)。按部位分层时,阴茎狭窄(OR 4.21,95% CI 1.3-13.8,P=0.02)和硬皮病(OR 2.91,95% CI 0.79-9.9,P=0.08)与术后并发症风险增加有关。在多变量分析中,只有阴茎狭窄具有显著性(OR 4.78,95% CI 1.2-19.4,P=0.03)。48%的患者(43人)在术后接受了计划外的医疗服务,不同组间的电话呼叫(37人)和急诊就诊(36人)人数相似:我们的研究表明,与住院治疗相比,XDS 尿道成形术与并发症发生率增加无关。这些数据支持在全民医疗保健环境中使用 XDS 路径对尿道狭窄进行资源节约型治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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