title: Anterior Urethroplasty Has Transitioned to an Outpatient Procedure Without Serious Rise in Complications: Data From the National Surgical Quality Improvement Program.
abstract: OBJECTIVE
  To analyze the trend in inpatient vs outpatient performance of anterior urethroplasty and examine outcomes using data from the National Surgical Quality Improvement Program database.
  
  
  METHODS
  A retrospective cross sectional analysis was performed using the National Surgical Quality Improvement Program database. Cases of single-stage anterior urethroplasty from 2006 to 2013 were identified using the International Classification of Diseases, Ninth Revision, procedure code 53410. Univariate analysis was performed to compare 30-day complication rates for inpatient and outpatient cases. A linear regression model was created for all years with greater than 50 reported cases.
  
  
  RESULTS
  A total of 326 anterior urethroplasties were reported; 222 (68.1%) were inpatient procedures, and 104 (31.9%) were outpatient procedures. The most common complication, urinary tract infection, was consistent between inpatient (2.7%) and outpatient (2.9%) procedures. The rate of wound dehiscence was significantly higher among outpatient cases (1.92% vs 0%, P = .03). There were no significant differences in the rates of wound infection, bleeding, graft failure, deep vein thrombosis, pneumonia, or sepsis. The linear regression model shows a significant increase in outpatient procedures (R2= 0.91) and equivalent decrease in inpatient procedures (R2= 0.91) for the last 3 years of the study period. Resident involvement was associated with a decreased rate of reoperation (0% vs 8.3% P <.001).
  
  
  CONCLUSIONS
  There has been a shift in the performance of anterior urethroplasty toward outpatient management. Overall, complication rates appear low. Future research is necessary to determine how to decrease overall cost of single-stage urethroplasty without compromising quality of care.
authors.affiliation: Department of Urology, Penn State Hershey Medical Center, Hershey, PA. Electronic address: smacdonald@hmc.psu.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: MacDonald
authors.affiliation: Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Devin
authors.initials: D
authors.lastname: Haddad
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Abraham
authors.initials: A
authors.lastname: Choi
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC; Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Marc
authors.initials: M
authors.lastname: Colaco
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC; Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Ryan
authors.initials: R
authors.lastname: Terlecki
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D058996:Quality Improvement; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D014481:United States; D014521:Urethra / Q000601:surgery; D014522:Urethral Diseases / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods