McAllister Mark, Rourke Keith F, Hoy Nathan
Division of Urology, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Can Urol Assoc J. 2023 Jun;17(6):176-182. doi: 10.5489/cuaj.8219.
Most centers have shifted to an extended day surgery (XDS ) model for urethroplasty. Our study characterizes outcomes and unplanned healthcare encounters of patients undergoing XDS urethroplasty compared to case-matched inpatient controls.
We conducted a retrospective, two-surgeon, single-center study of patients undergoing XDS urethroplasty (discharge <24 hrs) from November 2020 to November 2021. Patients were case-control matched based on age, stricture length, location, and etiology to patients who had previously undergone inpatient urethroplasty. Data was analyzed using descriptive and univariable statistics. Multivariable analysis by Cox proportional hazard regression was used to identify associations with postoperative complications.
Ninety patients (mean age=53.8 years) underwent XDS urethroplasty during the study period. Mean stricture length was 4.4 cm (standard deviation [SD ] 2.4). Rates of postoperative complications were similar between XDS (17%, n=15) and admitted patients (21%, n=19), and XDS was not associated with increased risk on univariable analysis (odds ratio [OR ] 0.65, 95% confidence interval [CI] 0.31-1.3, p=0.36). When stratifying by location, penile stricture (OR 4.21, 95% CI 1.3-13.8, p=0.02) and lichen sclerosus (OR 2.91, 95% CI 0.79-9.9, p=0.08) were associated with increased risk of postoperative complication. On multivariable analysis, only penile stricture was identified as significant (OR 4.78, 95% CI 1.2-19.4, p=0.03). Forty-eight percent (n=43) of patients had unplanned healthcare encounters postoperatively, with similar numbers of phone calls (n=37) and emergency department visits (n=36) between groups.
Our study shows that XDS urethroplasty is not associated with increased rates of complications relative to inpatient admission. This data supports using an XDS pathway for resource-efficient treatment of urethral strictures in a universal healthcare setting.
大多数医疗中心已转向采用延长日间手术（XDS）模式进行尿道成形术。我们的研究旨在描述接受XDS尿道成形术的患者与病例匹配的住院对照患者的治疗结果及意外医疗接触情况。
我们对2020年11月至2021年11月期间接受XDS尿道成形术（出院时间<24小时）的患者进行了一项回顾性、由两位外科医生参与的单中心研究。根据年龄、狭窄长度、位置和病因，将患者与此前接受住院尿道成形术的患者进行病例对照匹配。使用描述性和单变量统计方法对数据进行分析。通过Cox比例风险回归进行多变量分析，以确定与术后并发症的关联。
在研究期间，90例患者（平均年龄=53.8岁）接受了XDS尿道成形术。平均狭窄长度为4.4厘米（标准差[SD]2.4）。XDS组（17%，n = 15）和住院患者组（21%，n = 19）的术后并发症发生率相似，单变量分析显示XDS与风险增加无关（优势比[OR]0.65，95%置信区间[CI]0.31 - 1.3，p = 0.36）。按位置分层时，阴茎狭窄（OR 4.21，95% CI 1.3 - 13.8，p = 0.02）和硬化性苔藓（OR 2.91，95% CI 0.79 - 9.9，p = 0.08）与术后并发症风险增加相关。多变量分析显示，只有阴茎狭窄具有显著性（OR 4.78，95% CI 1.2 - 19.4，p = 0.03）。48%（n = 43）的患者术后有意外医疗接触，两组之间的电话咨询次数（n = 37）和急诊就诊次数（n = 36）相近。
我们的研究表明，与住院治疗相比，XDS尿道成形术的并发症发生率并未增加。该数据支持在全民医疗环境中使用XDS途径对尿道狭窄进行资源高效的治疗。
