Preoperative Testing for Urethroplasty is Not Associated With Outcomes-A NSQIP Study

Mishra, Kirtishri; Avila, Amanda; Mahran, Amr; Raina, Richa; Sidagam, Vasu; Ponsky, Lee; Gonzalez, Chris M.; Bukavina, Laura

doi:10.1016/j.urology.2020.02.018

Cited by 1 publication

(1 citation statement)

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“…Variables were considered in this model if they were significantly associated with complications on univariate analysis with p <.05, or if they significantly differed between patients who underwent laparoscopic vs open surgery. Of note, "unknown" values for INR, hematocrit level, WBC count, creatinine level, and albumin level were included as variables in this model to minimize the potential confounding effect of missing laboratory test values [15].…”

Section: Methodsmentioning

confidence: 99%

Perioperative Complications of Laparoscopic versus Open Surgery for Pelvic Inflammatory Disease

Carlson

Batra

Billow

et al. 2021

Journal of Minimally Invasive Gynecology

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To compare complications in patients undergoing laparoscopic vs open surgery for acute pelvic inflammatory disease (PID). Design: We performed a retrospective cohort study of patients who underwent surgery for PID, using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2015. Propensity score matching was used to balance baseline characteristics and compare complications in patients who underwent laparoscopic vs open surgery. Setting: Surgical management of acute PID. Patients: Patients with a preoperative diagnosis of PID were identified using International Classification of Diseases, Ninth Revision, codes. We excluded patients with chronic PID, gynecologic malignancy, and those for whom the surgical route was unknown. Interventions: Surgery for acute PID. Measurements and Main Results: The study included 367 patients. The mean age was 43.0 § 11.1 years, body mass index was 30.9 § 11.2 kg/m 2 , and American Society of Anesthesiology class was 2 (interquartile range 2−3). Preoperative signs of sepsis were noted in 33.8% of the patients, and septic shock was present in 1.4%. Hysterectomy was performed in 67.6%, oophorectomy in 12.0%, and salpingectomy in 4.6%. Complications were experienced by 114 patients (31.1%), 11 (3.0%) of which were potentially life-threatening. Multivariate logistic regression identified the following to be independently associated with complications: laparoscopy (adjusted odds ratio [aOR] 0.48; 95% confidence interval [CI], 0.3−0.8; p <.01), operative time (aOR 1.01; 95% CI, 1.00−1.01; p <.01), appendectomy (aOR 2.36; 95% CI, 1.0−5.4; p = .04), elevated international normalized ratio (aOR 2.30; 95% CI, 1.3−4.2; p <.01), and low hematocrit level (aOR 2.53; 95% CI, 1.4−4.5; p <.01). Propensity scores were calculated and used to generate a matched cohort of patients who underwent laparoscopic vs open surgery; the groups were similar, with p <.05 for all covariates. After balancing confounding variables, a laparoscopic approach to surgery remained significantly associated with a lower risk of complications (coefficient −0.07; 95% CI, −0.11 to −0.02; p = .008). Conclusion: Laparoscopy was associated with lower complication rates than open surgery in this well-matched cohort of patients who underwent surgery for acute PID.

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Section: Methodsmentioning

confidence: 99%