MP71-12: Ambulatory Artificial Urinary Sphincter and Male Urethral Sling Surgery Have Similar 30-Day Complication, Reoperation, and Readmission Rates: A National Analysis, 2016-2019
Medical Student Icahn School of Medicine at Mount Sinai
Introduction: Prior studies have compared complication rates following artificial urinary sphincter implantation (AUS) and male urethral sling placement (MUS). To the best of our knowledge, this is the first population-based comparative analysis of ambulatory AUS and MUS. Methods: Data from the American College of Surgeons National Surgical Quality Improvement database from 2016 to 2019 was used to identify all patients who underwent AUS (CPT 53445) and MUS (CPT 53440). Ambulatory surgery patients were selected based on a total hospital length of stay of zero days. We compared baseline characteristics, complication rates, reoperations, and readmissions between ambulatory AUS and MUS cohorts. Multivariate regression analysis controlling for available demographic and comorbidity data was used to evaluate the relationship between procedure type and adverse events. Results: A total of 963 AUS and 550 MUS surgeries were analyzed. Of these, surgery was performed on an ambulatory basis for 27.7% (n=267) of AUS and 60.5% (n=333) of MUS cases. There were no statistically significant changes in utilization of same-day discharge for AUS (p=0.33) or MUS (p=0.82) from 2016 to 2019. Compared to patients undergoing ambulatory MUS, ambulatory AUS patients were more likely to be over 65 years old (74.7% vs. 64.9%), White race (77.7% vs. 58.9%), hypertensive (63.8% vs. 55.6%), insulin-dependent (9.4% vs. 3.9%), chronic steroid users (5.3% vs. 2.1%), and diagnosed with disseminated cancer (2.3% vs. 0.3%) (all p<0.05). There was no difference in overall 30-day complication rates (3.4% AUS vs. 3.3% MUS, p=0.91). Likewise, there were no significant differences in Clavien-Dindo I/II rates (3.0% AUS vs. 2.4% MUS, p=0.64) or Clavien-Dindo IV rates (0.4% AUS vs. 0.9% MUS, p=0.44). There was no significant difference in 30-day reoperation rates (2.3% AUS vs. 1.8% MUS, p=0.69). There was a trend towards higher rates of 30-day readmission rate for ambulatory AUS at 3.4% versus 1.5% for MUS (p=0.13). However, after controlling for patient demographics and comorbidities on multivariate regression analysis, undergoing ambulatory AUS versus MUS did not confer significantly increased odds of 30-day complication (OR 0.71, 95% CI 0.25-1.97, p=.51), reoperation (OR 1.03, 95% CI 0.30-3.61, p=.96), or readmission (OR 1.75, 95% CI 0.45-6.77, p=.42). Conclusions: Using a national database, we found no significant differences in 30-day complication, reoperation, or readmission rates between ambulatory AUS and MUS. SOURCE OF Funding: None.
