Comparative evaluation of patient outcomes following extended day surgery urethroplasty at a Canadian tertiary care center
Mark McAllister1, Keith F. Rourke1, Nathan Hoy1.
1Department of Surgery, University of Alberta, Edmonton, AB, Canada
Introduction: Traditionally urethroplasty has required a 24–48-hour postoperative stay. With COVID-19 restrictions limiting inpatient beds, we have shifted urethroplasties to extended-day surgery (XDS) with discharge within 24 hours. Our study comparatively assessed 90-day complication rates for patients undergoing XDS urethroplasty.
Methods: We conducted a retrospective, single-center study of patients undergoing XDS urethroplasty (discharge <23 hours) from November 2020 to November 2021. Patients were then case-matched based on age, stricture length, and etiology to previous in-patient urethroplasties. Data was then analyzed using descriptive and univariate statistics.
Results: A total of 72 patients (mean age 53.9 years) underwent XDS urethroplasty during the study period. Median stricture length was 4 cm (interquartile range 3–5). Postoperative complications occurred in 12 patients (16%), which were all classified as Clavien-Dindo grade ≤II. Compared to case-controls, XDS urethroplasty was not associated with increased risk of 90-day complications (XDS=16%, inpatient=19%; odds ratio [OR] 0.829, 95% confidence interval [CI] 0.368–1.95, p=0.728). Odds of postoperative complication did not differ when stratifying for previous surgery, age (≥60; <60), or stricture length (≥5 cm; <5 cm). When stratifying by location, penile stricture trended towards increased odds of developing a postoperative complication (OR 2.36, 95% CI 0.982–5.88, p=0.085). Of patients with complications, 83% (n=10) presented to emergency, whereas 17% (n=2) phoned the clinic for assessment. Mean time to presentation for complications was 13.5 days, with clinic phone calls the most common contact method (n=20, 56%).
Conclusions: This is the first study assessing an expedited postoperative urethroplasty care pathway in Canada. Our study shows that XDS urethroplasty is not associated with increased complications relative to the prior standard of care. This data supports using an XDS pathway for efficient treatment of urethral strictures in a universal healthcare setting.
