AUA 2019: Is An Overnight Stay Necessary After Artificial Urinary Sphincter Insertion?

Chicago, IL (UroToday.com) This was a retrospective review, Artificial Urinary Sphincter insertions between June 2013 and September 2017 were identified by CPT code 53445. The authors aimed to determine whether inpatient management after AUS insertion, current local standard of care, is necessary with regards to pain control and immediate postoperative complications.

The medical records were reviewed for patient demographics, medical and surgical history, length of stay, postoperative narcotic use, and immediate postoperative complications.

There were 163 men identified who met inclusion criteria. The mean age and BMI were 69.3 + 9.4 years and 29.6 + 9.7 kg/m2, respectively. Twenty-three (14 %) patients were using chronic narcotic pain medication preoperatively, 33 (20%) were on anticoagulation other than ASA-81 mg, and 51 (31%) had diabetes (mean hemoglobin A1c 7.0 + 1.5 %). Patient history included radical prostatectomy (RP) alone in 95 (58%), radiation (XRT) alone in 15 (9%), and RP and XRT in 40 (25%). Twenty (12%) patients had a history of TURP or HoLEP, 14 of whom also had a history of RP and/or XRT. Sixteen (10 %) patients had a history of prior AUS._x000D_ 
All patients were discharged on the first postoperative day (POD 1) except for one patient discharged on POD 2. Two (1.2 %) patients experienced postoperative complications prior to discharge. One patient demonstrated altered mental status that resolved with conservative management (Clavien grade I) and the second displayed postoperative tachycardia requiring medical therapy (Clavien grade II). The 154 (94%) patients who required post-PACU narcotic pain medication used a median of 31.1 (IQR 15-45) morphine milligram equivalents (mme). The 82 (50%) patients who required post-PACU IV narcotic pain medication used a median of 4 (IQR 2-6) mme.

The authors conclude the that vast majority of patients underwent uncomplicated AUS insertions with minimal post-PACU IV narcotic requirements. Virtually all were discharged on POD 1. Transitioning to outpatient AUS insertion appears reasonable and may have a meaningful impact on patient experience and total costs

Presented by: Benjamin Dropkin, Vanderbilt University Medical Center, Department of UrologyNashville, Tennessee
Co-Authors: Jeremiah Dallmer, Leah Chisholm, Nashville, TN, Siobahn Hartigan, Sophia Delpe, Douglas Milam, Melissa Kaufman, Nashville, Nashville, Tennessee

Written by: Bilal Farhan, MD, Clinical Instructor, Female Urology and Voiding Dysfunction, Department of Urology, University of California, Irvine @BilalfarhanMD at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
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