Perioperative Outcomes of Male One-Stage Urethroplasty; Outcomes from a National Prospective Database
Valary T. Raup, MD; Pamela W. Lu, MD; Bjoern Loeppenberg, MD; Christian Meyer, MD; Malte Vetterlein, MD; Quoc-Dien Trinh, MD; Jairam Eswara, MD; Julie Szymaniak, MD
Brigham and Women's Hospital, Harvard Medical School, Boston, MA
BACKGROUND: There are few surgeons who perform a large number of male one-stage urethroplasties. Thus, the majority of the studies evaluating this specific surgery are retrospective and/or single-institution studies. We sought to assess the patient and perioperative characteristics of male one-stage urethroplasty using a large multi-institutional prospectively collected database.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2007-2013) was queried using Current Procedural Terminology (CPT) codes for one-stage urethroplasty (53410, 53415, 53431). Medical comorbidities, length of stay (LOS), operative time (pOT), 30-day complications (including infectious, thromboembolic, renal, cardiac, pulmonary, and neurologic events), and need for blood transfusion, re-intubation, or reoperation were analyzed.
RESULTS: Four hundred eighty male patients having undergone single stage urethroplasty were identified, with a median age of 48 years at the time of surgery (18-85). Median body mass index (BMI) was 29 (17-65) and median ASA score was 2 (1-3). The median procedure length was 167 minutes (65-507 minutes), and the median length of stay was 1 day (0-17). Twenty-nine patients developed post-operative complications within 30 days of surgery (6.0%): 13 urinary tract infections (UTIs), 3 superficial wound infections, 4 deep wound infections, 3 wound dehiscences, 1 post-operative pneumonia, 1 deep vein thrombosis, 2 myocardial infarctions, and 2 cases of sepsis. Two patients required blood transfusions, and 2 different patients required reoperation. There were no 30-day mortalities.
CONCLUSIONS: To our knowledge, our study represents the largest multi-institutional cohort of male patients having undergone single-stage urethroplasty. The patients in this study were relatively healthy and most patients were discharged within 24 hours. UTIs and wound infections/dehiscences were the most common 30-day complications recorded. While the rate of more severe complications was low, they did occur on occasion. Thus, patients should be counseled that while one-stage urethroplasty is an overall safe procedure with very few perioperative complications, infectious complications are the most likely complication to occur. Also, as with any surgery with a lengthy operative time, post-operative thromoembolic, pulmonary, and cardiac complications are possible.
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