Research Finds No Significant Differences in Complications for Outpatient Versus Inpatient Anterior Urethroplasty

Patients undergoing anterior urethroplasty may not need a hospital stay, according to the largest ever comparison of inpatient versus outpatient outcomes for the common procedure to repair urethral strictures. The study, led by researchers at Penn State Health Milton S. Hershey Medical Center, was published in the journal Urology in 2017.

Dr. Susan MacDonald, an assistant professor in the Department of Urology at Penn State College of Medicine, and colleagues examined data from the American College of Surgeons National Surgical Quality Improvement Program database, which comprises more than 500 hospitals.

Between 2006 through 2013, surgeons at reporting hospitals performed 326 single-stage anterior urethroplasties. The average operating time was 59 minutes longer for inpatient procedures, and the average length of stay for inpatient procedure was 1.9 days compared with 0.43 days for outpatient procedures.

When the researchers analyzed 30-day complication rates, they found no significant difference in the rates of urinary tract infections—the most common complication—between inpatient and outpatient surgeries. No major differences were noted in the rates of bleeding, deep vein thrombosis, graft failure, pneumonia, myocardial infarction or sepsis.

One complication was more common among outpatients. The rates of wound dehiscence, or separation, were significantly higher for outpatient (1.9 percent) versus inpatient (0 percent) procedures. However, the researchers noted that wound separation was rare and that none of the outpatient cases needed reoperation within 30 days. (Longer-term data were not available.) The complication could be related to increased postoperative activity in outpatients compared with inpatients, although this is unclear.

A trend also showed toward more superficial wound infections among outpatients, but this finding was not statistically significant. Inpatients had higher rates of reoperation and readmission, but these differences also didn’t reach significance.

Although there were more inpatient procedures overall (68.1 percent), there was a shift toward outpatient procedures at the end of the study period without a serious rise in complications. The researchers concluded “the evidence seems to strongly support that outpatient management is appropriate for single-stage anterior urethroplasty.”