Hypothesis / aims of study
Artificial urinary sphincter (AUS) implantation is the gold standard for surgical treatment of male stress urinary incontinence but carries a 50% long-term revision rate. Prior studies have noted medical risk factors for AUS complications such as hypertension, diabetes, cardiovascular disease, peri-operative anticoagulation use, and low pre-operative serum albumin [1]. Few studies have investigated risk factors for short term reoperation in an adult population. We sought to investigate risk factors for short-term AUS reoperation using the National Surgical Quality Improvement Program (NSPIQ) database.
Study design, materials and methods
Male patients who underwent AUS implantation between 2012-2022 were queried from the NSQIP database using CPT code 53445. The primary outcome was reoperation within 30 days. Patient characteristics and pre-operative laboratory findings were compared between outcome groups with the appropriate t-test, Chi-squared, or Fisher's exact test. Binary logistic regression was utilized to calculate unadjusted (univariate) and adjusted (multivariate) odds ratio for variables that were significantly different between outcomes (SPSS v 27.0).
Results
1,884 cases were identified. Forty-three (2.3%) cases required reoperation within 30-days. Patients requiring reoperation within 30-days were older (71.9 vs 69.5, p=.033) and more likely to be insulin-dependent diabetics (IDDM) (18.6% vs 7.6%, p=.05). There was a higher percentage of African American patients in the reoperation group (20.5% vs 10.8%, p=.041). No significant associations were found between 30-day reoperation and BMI, outpatient setting, smoking history within one year, or preoperative laboratory values. There were no associations between reoperation and medical comorbidities such as non-insulin dependent diabetes, dyspnea, severe COPD, congestive heart failure, hypertension, dialysis, bleeding disorders, disseminated cancer, or immunosuppression. Univariate logistic regression found that African Americans and IDDM had a 2-fold and nearly 3-fold increased odds of reoperation within 30-days, respectively (p=.041, p=.011). When adjusting for covariates, only IDDM remained significant (aOR: 2.68, p=.020).
Interpretation of results
Patients who required short-term reoperation were more likely to be older, of African ancestry, and to have insulin-dependent diabetes. When accounting for multiple variables, only IDDM was associated with significantly increased odds of short term reoperation. Those with IDDM bear nearly 3-fold increased odds of reopration when adjusting for other covariates.