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 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.


CONCLUSIONS
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.
Department of Urology, University of California, San Francisco, San Francisco, CA.
Sarah D
SD
Blaschko
Department of Urology, University of California, San Francisco, San Francisco, CA.
Catherine R
CR
Harris
Department of Urology, University of California, San Francisco, San Francisco, CA.
Uwais B
UB
Zaid
Department of Urology, University of California, San Francisco, San Francisco, CA.
Tom
T
Gaither
Department of Urology, University of California, San Francisco, San Francisco, CA.
Carissa
C
Chu
Department of Urology, University of California, San Francisco, San Francisco, CA.
Amjad
A
Alwaal
Department of Urology, University of California, San Francisco, San Francisco, CA.
Jack W
JW
McAninch
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
Charles E
CE
McCulloch
Department of Urology, University of California, San Francisco, San Francisco, CA. Electronic address: bbreyer@urology.ucsf.edu.
Benjamin N
BN
Breyer
D000293:Adolescent; D000328:Adult; D000368:Aged; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014481:United States; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000706:statistics & numerical data / Q000639:trends; D055815:Young Adult