Same Day Discharge Versus Overnight Observation Protocols – Similar Outcomes Following Artificial Urinary Sphincter Surgery

Dropkin, Benjamin M.; Sanders, Sarah C.; Kavoussi, Mehraban; Shaaban, Aziz; Joice, Gregory; Hudak, Steven J.; Lotan, Yair; Morey, Allen F.

doi:10.1016/j.urology.2021.08.016

Cited by 5 publications

(10 citation statements)

References 12 publications

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“…A recent study has shown that day-of-surgery discharge after AUS is safe for patients; however, in these populations, catheters have been left in place on discharge [ 3 ]. While this is often viewed as a minor inconvenience, catheters increase the risk of infection, can be accidentally removed, and can fail to work as intended.…”

Section: Discussionmentioning

confidence: 99%

“…For patients who travel far distances or are uncomfortable removing their own catheters, this also poses a problem regarding their follow-up care. Catheter removal in the immediate post-operative setting has often been considered risky; however, most large studies have shown only a 3%-5% risk of post-operative retention when catheters are removed the morning after surgery [ 3 , 7 - 9 ]. It is then reasonable to question whether a catheter placement is needed following the surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Additional studies have shown a low risk of immediate complications and the need for narcotics following AUS implantation [2]. Another recent study shows day of surgery discharge following AUS implantation with a urinary catheter in place is a safe management strategy from both a surgical and anesthesia standpoint [3].…”

Section: Introductionmentioning

confidence: 99%

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Catheter Free Day of Surgery Discharge vs Overnight Observation Following Artificial Urinary Sphincter Placement

Myrga¹,

Vasan²,

Miller³

et al. 2023

Cureus

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IntroductionTo confirm the safety and examine outcomes of a day of surgery discharge following artificial urinary sphincter implantation in a population discharged without a catheter. MethodsWe retrospectively identified 110 patients, 31 of whom were discharged on the day of surgery, from a single surgeon following artificial urinary sphincter implantation. After institutional board review approval, patient charts were reviewed capturing demographics as well as three, thirty, and ninety-day outcomes. Further outcomes specific to urinary retention were obtained. ResultsPatients who were discharged the same day were older (71 vs. 68), had shorter operative times (92 minutes vs 109 minutes), and were less likely to have been smokers (6% vs 31%). There were no differences in the proportion of patients who underwent prior radiation or prior implant surgery. There was no significant difference in the number of patients who had emergency department visits, urinary retention, office calls, office visits, or unplanned office visits at all time points following surgery. There was no significant difference in overall urinary retention (15% vs 5%), retention presenting after the initial surgical event (6% vs 5%), or need for a suprapubic tube (0% vs 5%). ConclusionsDay of surgery discharge is a safe discharge strategy for patients who have undergone artificial urinary sphincter placement. Furthermore, catheter-free days of discharge surgery did not have a significantly greater risk of urinary retention, office calls, emergency department (ED) visits, or office visits compared to our overnight observation population. This approach should be considered for all patients undergoing artificial urinary sphincter (AUS) implantation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Catheter Free Day of Surgery Discharge vs Overnight Observation Following Artificial Urinary Sphincter Placement

Myrga¹,

Vasan²,

Miller³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…We identified an increased risk of 3 month complications and infection with patients admitted postoperatively, but a lower risk of revision/removal. While the majority of AUS insertion patients are discharged the same day, admitted patients tend to be older and more medically complex 20 . Patients also may have been admitted due to intraoperative complications or earlier diagnosis of device issues, which preempts a later surgical event that was not caught in same‐day discharge patients.…”

Section: Discussionmentioning

confidence: 99%

Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery

Sun

Callegari

Zhou

et al. 2023

Neurourology and Urodynamics

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Introduction and Objective Perioperative antimicrobial prophylaxis is crucial for prevention of prosthesis and patient morbidity after artificial urinary sphincter (AUS) placement. While antibiotic guidelines exist for many urologic procedures, adoption patterns for AUS surgery are unclear. We aimed to assess trends in antibiotic prophylaxis for AUS and outcomes relative to American Urological Association (AUA) Best Practice guidelines. Methods The Premier Healthcare Database was queried from 2000 to 2020. Encounters involving AUS insertion, revision/removal, and associated complications were identified via ICD and CPT codes. Premier charge codes were used to identify antibiotics used during the insertion encounter. AUS‐related complication events were found using patient hospital identifiers. Univariable analysis between hospital/patient characteristics and use of guideline‐adherent antibiotics was done via chi‐squared and Kruskal–Wallis tests. A multivariable logistic mixed effects model was used to assess factors related to the odds of complication, specifically the use of guideline‐adherent versus nonadherent regimens. Results Of 9775 patients with primary AUS surgery, 4310 (44.1%) received guideline‐adherent antibiotics. The odds of guideline‐adherent regimen use increased 7.7% per year with 53.0% (830/1565) receiving guideline‐adherent antibiotics by the end of the study period. Patients with guideline‐adherent regimens had a decreased risk of any complication (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.74–0.93) and surgical revision (OR: 0.85, 95% CI: 0.74–0.96) within 3 months; however, no significant difference in infection within was noted (OR: 0.89, 95% CI: 0.68–1.17) within 3 months. Conclusions Adherence to AUA antimicrobial guidelines for AUS surgery appears to have increased over the last two decades. While guideline‐adherent regimens were associated with decreased risk of any complication and surgical intervention, no significant association was found with risk of infection. Surgeons appear to be increasingly following AUA recommendations for antimicrobial prophylaxis for AUS surgery, however, further level 1 evidence should be obtained to demonstrate conclusive benefit of these regimens.

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“…In another retrospective single institution study at a high-volume tertiary care academic medical center, Dropkin et al analyzed 525 AUS cases between August 2013 and January 2020, with 318 cases in the same day surgery (SDS) group and 207 cases in the overnight observation (OBS) group (19). The SDS group showed a slightly lower American Society of Anesthesia (ASA) score, but were more likely to have hypertension.…”

Section: Outpatient Surgerymentioning

confidence: 99%

Changes and debates in male stress urinary incontinence surgery practice patterns: a contemporary review

Desai¹,

Rozanski²

2023

Transl Androl Urol

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Surgery plays a crucial role in the definitive management of male stress urinary incontinence (SUI). The most utilized and well-studied surgical options include the artificial urinary sphincter (AUS) and the male sling (MS). The AUS has long been considered the "gold standard" and more versatile option in this space, showing effectiveness in mild, moderate, and severe SUI cases, whereas the MS is preferred in cases of mild to moderate SUI. Not surprisingly, and importantly, much of the published literature on male stress incontinence has focused on determining the "ideal" candidate for each procedure and identifying which clinical, device-specific, and patient factors play an important role in the objective and subjective success rates. There are, however, more granular, and sometimes debatable, topics to assess regarding the real-life practice patterns of male SUI surgery. The aim of this clinical practice review is to examine current trends of several of these topics including: AUS vs. MS utilization, the prevalence of outpatient procedures, 3.5 cm AUS cuff use, preoperative urine studies utilization, and intraoperative and postoperative antibiotics.As with many things in surgery, dogma rather than evidence-based medicine can significantly influence everyday clinical decision making. We seek to highlight which practice patterns in male SUI surgery are changing and/or being challenged and debated.

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Same Day Discharge Versus Overnight Observation Protocols – Similar Outcomes Following Artificial Urinary Sphincter Surgery

Cited by 5 publications

References 12 publications

Catheter Free Day of Surgery Discharge vs Overnight Observation Following Artificial Urinary Sphincter Placement

Catheter Free Day of Surgery Discharge vs Overnight Observation Following Artificial Urinary Sphincter Placement

Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery

Changes and debates in male stress urinary incontinence surgery practice patterns: a contemporary review

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