PD28-08: Sagacity of Same Day Discharge: Incidence and Timing of Postoperative Adverse Events Following Minimally Invasive Urologic Surgery

Saturday, September 11, 2021 8:00 PM to 10:00 PM
Abstract

Information

Authors: Kevin Ginsburg, Alberto Andres Castro Bigalli, Rosalia Viterbo, Richard Greenberg, Robert Uzzo, David Chen, Marc Smaldone, Alexander Kutikov, Andres Correa

Introduction: In efforts to judiciously utilize resources and contain cost, there has been increasing efforts to reduce postoperative length of stay, resulting in several groups promoting same day discharge (SDDC) for patients undergoing minimally invasive prostatectomy (MIP) and minimally invasive partial nephrectomy (MIpN). We aimed to 1) describe the incidence and timing of adverse events, readmission, reoperation and death and 2) compare the incidence of these outcomes for patients undergoing SDDC and non-SDDC following MIP and MIpN.

Methods: We review the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for patients undergoing MIP and MIpN from 2015 to 2019. The primary outcomes was to describe the incidence of adverse events, readmission, reoperation, and death and the timing of these outcomes after surgery. Additionally, we compared the incidence of outcomes of interest between patients undergoing same day discharge (SDDC) vs. non-SDDC using the chi-squared test.

Results: A total of 64,975 patients underwent MIP (46,869) and MIpN (18,106), of which 650 (1%) had a SDDC. SDDC patients tended to be younger (median 61, IRQ 55-68) compared with non-SDDC patients (median 63, IRQ 57-68, p<0.001). We noted 4,593 complications in 3,560 (5.5%) patients, including 1,057 (1.6%) blood transfusions, 129 (0.2%) myocardial infarctions, 86 (0.1%) cardiac arrests, 433 (0.7%) DVTs, 359 (0.6%) PEs, 55 (0.1%) CVAs, 167 (0.3%) patients being intubated, 99 (0.2%) remaining intubated >48hrs after surgery, 360 (0.6%) patients developing sepsis, 81 (0.1%) cases of septic shock, 280 (0.4%) cases of pneumonia, 1,299 (2.0%) UTIs and 87 deaths (0.1%). Compared with non-SDDC patients, SDDC patients had similar incidence of any complication (5.2% vs. 5.4%, p=0.830), reoperation (0.9% vs. 1.3%, p=0.372), readmission (3.5% vs. 4.4%, p=0.268), or death (0.16% vs. 0.13%, p=0.836). Regarding the timing of adverse events, 984/1057 (93%) blood transfusions, 59/129 (46%) myocardial infarctions, 40/86 (47%) cardiac arrests, 91/397 (23%) reoperations, 219/2857 (8%) readmissions, and 14/87 (16%) deaths occurred within 2 days of the index surgery.

Conclusions: The perioperative period for patients undergoing MIP and MIpN remains a critical period in which serious adverse events do occur. Same day discharge may be a viable option for select patients, but a period of observation to ensure patients safety should remain the standard of care for most individuals undergoing MIP and MIpN.

Source of Funding: None
Therapeutic Area
Health PolicyPractice Management