Journal of endourology
-
Journal of endourology · Apr 2014
Multicenter Study Comparative StudyNational multi-institutional comparison of 30-day postoperative complication and readmission rates between open retropubic radical prostatectomy and robot-assisted laparoscopic prostatectomy using NSQIP.
Many American hospitals will soon face readmission penalties deducted from Medicare reimbursements, which will place further scrutiny on techniques that may offer reduced postoperative morbidity. We aimed to perform the first multi-institutional study using the National Surgical Quality Improvement Program (NSQIP) database, to compare predictors of readmission within cohorts of open radical retropubic prostatectomy (RRP) and robot-assisted laparoscopic radical prostatectomy (RALRP) in a contemporary nationwide series of radical prostatectomy. ⋯ This is the first multi-institutional retrospective study that examines readmission rates and procedural intracohort predictors of readmission for RRP in the contemporary United States. We report a significant difference in postoperative complication and readmission rates in RRP compared with RALRP. Further prospective analysis is warranted.
-
Journal of endourology · Apr 2014
A prospective study examining the association between preoperative frailty and postoperative complications in patients undergoing minimally invasive surgery.
Current surgical decision-making is overly subjective and often misjudges a patient's physiologic state. The concept of frailty has gained recent recognition and potentially represents a measureable phenotype, which can quantify a patient's physiologic reserve and risk of an adverse surgical outcome. We sought to investigate the relationship between preoperative markers of frailty and postoperative complications in patients undergoing minimally invasive surgery (MIS). ⋯ The advent of MIS has potentially lured surgeons into thinking older and patients with comorbidities may more easily tolerate this surgical approach compared with traditional open techniques. Our data suggest, however, that intermediately frail or frail patients are at increased risk of experiencing postoperative complications compared with not frail patients.
-
Journal of endourology · Mar 2014
Multicenter StudyPostoperative complications after percutaneous nephrolithotomy: a contemporary analysis by insurance status in the United States.
No published data to date have assessed the insurance-related disparities among patients undergoing percutaneous nephrolithotomy (PCNL). Our objective was to examine whether being uninsured is associated with more perioperative complications after PCNL in the United States and to determine possible risk factors that influence PCNL outcomes. ⋯ Perioperative morbidity after PCNL varied significantly with insurance status, but this variation was explained mostly by differences in overall health status.
-
Journal of endourology · Mar 2014
Laparoscopic radical prostatectomy demonstrates less morbidity than open radical prostatectomy: an analysis of the American College of Surgeons-National Surgical Quality Improvement Program database with a focus on surgical trainee involvement.
Complication rates of open radical prostatectomies (ORPs) and laparoscopic radical prostatectomies (LRPs) performed by highly experienced surgeons in centers of excellence are well known. Using a standardized, national, risk-adjusted surgical database, we compared 30-day outcomes following ORP and LRP and analyzed how trainee involvement influenced outcomes. ⋯ The large sample size, standardized data definitions, and quality control measures of the ACS-NSQIP database allow for in-depth analysis of subtle, but significant differences in outcomes between groups. Trainee involvement in LRP appears safe to patients. However, the increased morbidity in ORP involving trainees may be mitigated by awareness, simulation laboratories, and standardized competency assessment.
-
Journal of endourology · Feb 2014
Comparative StudyRetroperitoneal laparoendoscopic single-site adrenalectomy for pheochromocytoma: our single center experiences.
To evaluate the feasibility and safety of retroperitoneal laparoendoscopic single-site adrenalectomy for pheochromocytoma (LESS-PHEO) and summarize our initial experience. ⋯ Although more training and practice are needed to shorten its operative time, LESS-PHEO, as performed by an experienced laparoscopic urologist, is a feasible and safe procedure associated with less postoperative pain and faster recovery.