ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2023 June;75(3):381-7

DOI: 10.23736/S2724-6051.22.04893-5

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

The impact of surgical volume on perioperative safety after urethroplasty: a population-based study

Giuseppe BASILE ¹ ✉, Pierre I. KARAKIEWICZ ², Zhe TIAN ², Radoš DJINOVIĆ ³, Francesco MONTORSI ¹, Guido BARBAGLI ⁴, Pankaj JOSHI ⁵, Sanjay B. KULKARNI ⁵, Marco BANDINI ^{1, 2, 4, 5}

¹ Unit of Urology, Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; ² Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CR-CHUM), Cancer Institute of Montréal, Montréal, QC, Canada; ³ Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, Belgrade, Serbia; ⁴ Centro Chirurgico Toscano, Arezzo, Italy; ⁵ Kulkarni Reconstructive Urology Center, Pune, India

BACKGROUND: The aim of the study was to assess whether the risk of perioperative complications after urethroplasty was affected by hospital annual surgical volume (ASV).
METHODS: In the Nationwide Inpatient Sample, we searched for patients who underwent urethroplasty between 2001 and 2015. Hospitals were categorized into empirically determined tertiles, according to ASV of performed urethroplasties and divided into low (<3) (LVC), intermediate (3-19) (IVC) and high (>20) volume centers (HVC). Multivariable logistic regression (MLR) analyses examined the effect of ASV on perioperative complications and on four specific sub-types of post-operative complications.
RESULTS: A weighted estimate of 39 912 patients underwent urethroplasty in the US. 34.9% were operated in HVC, while the rate of performed urethroplasties increased in LVC and decreased in HVC. Overall, 1.1%, 18.8% and 2.1% patients respectively experienced intraoperative, post-operative, and transfusions complications. At MLR, IVC and LVC were associated with higher risk of both intraoperative (IVC: OR 2.65, P=0.0008; LVC: OR 4.98, P<0.0001), post-operative (IVC: OR 1.14, P=0.01; LVC: OR 1.26, P=0.001) and transfusions complications (IVC: OR 1.85, P<0.001; LVC: OR 3.03, P=0.01). LVC was also associated with higher risk of hematuria (OR 3.77), urinary infections (OR 1.60) and sepsis (OR 2.83) complications.
CONCLUSIONS: Approximately 65% of patients were operated in IVC and LVC, and patients treated in IVC or LVC had higher risk of developing both intra and post-operative complications. These data provide important indicators for policy makers to categorize institution based on urethroplasty outcomes.

KEY WORDS: Complications; Urology; Surgical procedures, operative