Lacy John M, Madden-Fuentes Ramiro J, Dugan Adam, Peterson Andrew C, Gupta Shubham
Department of Urology, University of Tennessee Health Sciences Center Graduate School of Medicine, Knoxville, TN.
Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC.
Urology. 2018 Jan;111:197-202. doi: 10.1016/j.urology.2017.08.006. Epub 2017 Aug 18.
To determine the characteristics and predictors of perioperative complications after male anterior urethroplasty.
The American College of Surgeons-National Surgical Quality Improvement Program is a validated outcomes-based program comprising academic and community hospitals in the United States and Canada. Data from 2007 to 2015 were queried for single-stage anterior urethroplasty using Current Procedure Terminology codes. The primary outcome was frequency of complications within the 30-day postoperative period. Preoperative and intraoperative parameters were correlated with morbidity measures, and univariate and multivariate regression analyses were used.
A total of 555 patients underwent anterior urethroplasty, of whom 180 (32.4%) had graft or flap placement. Of the patients, 127 (22.9%) went home the same day after surgery, 255 (45.9%) stayed for 1 night, and 173 (31.2%) stayed for 2 or more nights. No deaths, cardiovascular complications, or sepsis were noted. Forty-seven patients (8.5%) had complications in the 30-day period. The most common complications were infection (57.4%), readmission (42.9%), and return to the operating room (17%). On univariate analysis, patients who had substitution urethroplasty (P = .04) and longer operative times (P = .002) were more likely to have complications, but only longer operative time showed significance on multivariate analysis (P = .006). Age, American Society of Anesthesiologists score, and length of stay were not predictive of complication frequency.
Anterior urethroplasty has low postoperative morbidity. Longer operative times were associated with increased rate of complications. Longer hospital stay after surgery is not protective against perioperative complications.
确定男性前尿道成形术后围手术期并发症的特征及预测因素。
美国外科医师学会-国家外科质量改进计划是一个经过验证的基于结果的项目，涵盖美国和加拿大的学术及社区医院。使用当前手术操作术语编码查询2007年至2015年单阶段前尿道成形术的数据。主要结局是术后30天内并发症的发生率。将术前和术中参数与发病率指标进行相关性分析，并采用单因素和多因素回归分析。
共有555例患者接受了前尿道成形术，其中180例（32.4%）进行了移植物或皮瓣植入。患者中，127例（22.9%）术后当天出院，255例（45.9%）住院1晚，173例（31.2%）住院2晚或更长时间。未观察到死亡、心血管并发症或败血症。47例患者（8.5%）在30天内出现并发症。最常见的并发症是感染（57.4%）、再次入院（42.9%）和返回手术室（17%）。单因素分析显示，接受替代尿道成形术的患者（P = 0.04）和手术时间较长的患者（P = 0.002）更易发生并发症，但多因素分析仅显示手术时间较长具有统计学意义（P = 0.006）。年龄、美国麻醉医师协会评分和住院时间不能预测并发症发生率。
前尿道成形术术后发病率较低。手术时间较长与并发症发生率增加相关。术后住院时间延长并不能预防围手术期并发症。
