Presentation Authors: Stephanie Sexton, Brian Inouye*, Urszula Kowalik, Tracy Truong, Magaratha Kuchibhatla, Andrew Peterson, Durham, NC
Introduction: Many urologists are hesitant to offer surgical treatment for urinary incontinence in the genitourinary cancer survivor with significant comorbidities. We used the Charlson Comorbidity Index (CCI) and Frailty Index (FI) to investigate the relationship between preoperative comorbidity and immediate outcomes after artificial urinary sphincter (AUS) implantation. We hypothesized that even high-risk patients do well with this surgery.
Methods: Using the National Surgical Quality Improvement Program (NSQIP), patients with CPT codes for AUS implantation were identified between 2007 and 2015. The patientâ€™s CCI was calculated based on ICD-9 codes. We calculated a FI score for each patient by adding the number of FI conditions the patient had, based on ICD-9 diagnoses. Complications were identified based on definitions in NSQIP and converted to Clavien-Dindo classification grades. Weighted descriptive statistics were calculated. Weighted multivariate logistic regression was used to examine the association between Grade I, Grade III, and overall complication and CCI, controlling for anesthesia type and race. We also used logistic regression to study the association between Grade I, Grade III, and overall complication and FI, controlling for age, anesthesia type, and race.
Results: We reviewed data on 1370 patients. The mean age of patients was 70 Â± 9.6 years old. 77% were Caucasian and the mean BMI was 29.6. 96% of patients had general anesthesia. The mean CCI was 4.0 Â± 1.4. 47% of patients had only 1 FI condition whereas 25% had 2 or more FI conditions. For each post-operative complication recorded in NSQIP, less than 3% of the patients in this population exhibit any of these complications. Therefore, we only modeled Clavien-Dindo Grade I, III and overall complication. After adjusting for anesthesia and race, there were no association between having each of Grade I (OR = 1.11; 95% CI = 0.89, 1.38; p-value = 0.36), Grade III (OR = 1.09; 95% CI = 0.88, 1.35; p-value= 0.45), or overall complication (OR = 1.10; 95% CI = 0.93, 1.29; p-value = 0.26) and CCI scores. Similar results were observed between having no FI conditions or any amount of FI conditions.
Conclusions: AUS implantation is a safe procedure with low complication rates even in the patient with significant comorbidities.