Presentation Authors: Marco Bandini*, Milan, Italy, Rados Djinovic, Belgrade, Serbia, Francesco Montorsi, Milan, Italy, Sasha Sekulovic, Nikola Stanojevic, Milan Slavkovic, Belgrade, Serbia, Bogdan Spiridonescu, Bucharest, Romania, Zhe Tian, Montréal, Canada, Vladislav Pesic, Belgrade, Serbia, Pramod Krishnappa, Bangalore, India, Anuj Deep Dangi, Tamil Nadu, India, Salvatore Sansalone, Roma, Italy, Andrea Salonia, Alberto Briganti, Milan, Italy, Pierre Karakiewicz, Montréal, Canada
Introduction: As more and more fellowship trained urologists are performing urethroplasty, an objective assessment of outcomes in relation to the case load can serve as a quality improvement index. We aim to assess the risk of perioperative complications in relation to the AHV, as no previous literature exists on the topic.
Methods: Within the Nationwide Inpatient Sample, we searched for patients underwent urethroplasty (2001-2015). Hospitals were categorized in tertile according to AHV: low ( < 3 urethroplasties) volume centers (LVC), intermediate (3-19) volume centers (IVC) and high (> 20) volume centers (HVC). We analyzed trends in urethroplasty procedures according to AHV. Multivariable logistic regression (MLR) examined the effect of AHV on intraoperative complications, postoperative complications and transfusion rate. Finally, 9 sets of MLRs examined the effect of AHV on 9 sub-types of postoperative complications: gastrointestinal, vascular, neurologic, cardiac, respiratory, haematuria, urinary tract infections, sepsis and wound infections.
Results: Of a weighted estimate of 36773 urethroplasties, 13932 (34.9%), 15208 (38.1%), and 10773 (27%) were operated in HVC, IVC and LVC, respectively. Within the study period, the rate of performed urethroplasties increased in LVC (EAPC +6%, p= 0.02), remained stable in IVC (EAPC -0.1%, p=0.9) and decreased in HVC (EAPC -3%, p= 0.03). Overall, 456 (1.1%) and 7517 (18.8%) patients respectively experienced intraoperative and postoperative complications, and 843 (2.1%) received transfusions. In MLR, IVC and LVC were associated with higher risk of intraoperative (IVC: OR 2.5, p=0.01; LVC: OR 5.1, p < 0.001) and postoperative (IVC: OR 1.2, p=0.03; LVC: OR 1.7, p < 0.001) complications. Additionally, LVC was associated with higher risk of transfusions (OR 3.1, p < 0.001). Finally, LVC was associated with higher risk of gastrointestinal (OR 2.5), cardiac (OR 3.9) and respiratory (OR 2.3) complications, as well as of higher risk of haematuria (OR 3.6), urinary tract infections (OR 1.5) and sepsis (OR 2.7). Conversely, IVC was associated only with higher risk of cardiac complications (OR 1.9).
Conclusions: We found that approximately 65% of patients were operated in IVC and LVC. Moreover, there was a trend toward lower number of urethroplasty in HVC. Additionally, we found that the rates of intra and postoperative complications were considerably higher in LVC and IVC than in HVC. These data provide important indicators for policy makers to provide benchmarks for treatment and to categorize institution based on urethroplasty outcomes.