Trends, Utilization, and Immediate Perioperative Complications of Urethroplasty in the United States: Data From the National Inpatient Sample 2000-2010

Objective To determine national urethroplasty trends based on type of surgery and patient and hospital characteristics. We hypothesized that the number of complex urethroplasty procedures performed has increased over time and may be associated with increased periprocedure complications. Methods The...

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Published in:Urology (Ridgewood, N.J.) N.J.), 2015-05, Vol.85 (5), p.1190-1194
Main Authors: Blaschko, Sarah D, Harris, Catherine R, Zaid, Uwais B, Gaither, Tom, Chu, Carissa, Alwaal, Amjad, McAninch, Jack W, McCulloch, Charles E, Breyer, Benjamin N
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Hospitals
Humans
Inpatients
Male
Middle Aged
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Time Factors
United States
Urethra - surgery
Urethral Stricture - surgery
Urologic Surgical Procedures, Male - adverse effects
Urologic Surgical Procedures, Male - trends
Urologic Surgical Procedures, Male - utilization
Urology
Young Adult
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Summary:Objective To determine national urethroplasty trends based on type of surgery and patient and hospital characteristics. We hypothesized that the number of complex urethroplasty procedures performed has increased over time and may be associated with increased periprocedure complications. Methods The National Inpatient Sample from years 2000 to 2010 was queried for patients with urethroplasty-associated International Classification of Diseases, Ninth Revision, Clinical Modification codes. We analyzed trends in urethroplasty procedures, patient demographics, comorbidities, and hospital characteristics. We evaluated the relationship between patient demographics and comorbid disease, length of hospital stay, hospital charges, and inpatient complications. Results During the study period, an estimated 13,700 men (95% confidence interval, 9507-17,894) underwent urethroplasty nationally. Excision with primary anastomosis, buccal graft, and other graft or flap urethroplasty comprised 80.3%, 14.3%, and 5.4%, respectively. Buccal mucosa graft procedures increased over time ( P  = .03). Only 1.6% of hospitals have ≥20 urethroplasties performed annually. Urethroplasty type and urethroplasty volume were not associated with immediate complication rates. Hypertension, diabetes, chronic pulmonary disease, and obesity were the most common comorbidities in urethroplasty patients. Complications during urethroplasty hospitalization occurred in 6.6% of men, with surgical or wound complications being the most common (5.2%). Postoperative mortality was exceedingly rare. Older patients, African Americans, and patients with increased comorbidities were more likely to have complications. Conclusion An increasing number of buccal mucosa graft urethroplasties occurred over time. Urethroplasty patients have low immediate perioperative morbidity (6.6%) and mortality (0.07%). Patients who are older, African American, or have more comorbid conditions have greater risk for complications.
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2015.01.008