IS AN OVERNIGHT STAY NECESSARY AFTER ARTIFICIAL URINARY SPHINCTER INSERTION?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy II (PD37)1 Apr 2019PD37-09 IS AN OVERNIGHT STAY NECESSARY AFTER ARTIFICIAL URINARY SPHINCTER INSERTION? Benjamin Dropkin*, Jeremiah Dallmer, Leah Chisholm, Siobahn Hartigan, Sophia Delpe, Douglas Milam, and Melissa Kaufman Benjamin Dropkin*Benjamin Dropkin* More articles by this author , Jeremiah DallmerJeremiah Dallmer More articles by this author , Leah ChisholmLeah Chisholm More articles by this author , Siobahn HartiganSiobahn Hartigan More articles by this author , Sophia DelpeSophia Delpe More articles by this author , Douglas MilamDouglas Milam More articles by this author , and Melissa KaufmanMelissa Kaufman More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556365.69608.21AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Artificial Urinary Sphincter (AUS) insertion is the most effective treatment for moderate to severe incontinence in men. With over 3500 devices placed annually in the United States, a significant cost burden is associated with inpatient care. We sought to determine whether inpatient management after AUS insertion, our current local standard of care, is necessary with regards to pain control and immediate postoperative complications. METHODS: In this IRB approved, retrospective review, AUS insertions between June 2013 and September 2017 were identified by CPT code 53445. Medical records were reviewed for patient demographics, medical and surgical history, length of stay, postoperative narcotic use, and immediate postoperative complications. RESULTS: We identified 163 men 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. 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. CONCLUSIONS: The 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. Source of Funding: None Nashville, TN; Nashville, TN; Nashville, TN© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e665-e665 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Dropkin* More articles by this author Jeremiah Dallmer More articles by this author Leah Chisholm More articles by this author Siobahn Hartigan More articles by this author Sophia Delpe More articles by this author Douglas Milam More articles by this author Melissa Kaufman More articles by this author Expand All Advertisement PDF downloadLoading ...