Mp24-16 Ureteroscopy at Ambulatory Surgery Centers Can Be Safe for Carefully Selected High-Risk Patients

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP24)1 May 2024MP24-16 URETEROSCOPY AT AMBULATORY SURGERY CENTERS CAN BE SAFE FOR CAREFULLY SELECTED HIGH-RISK PATIENTS Ryan Cook, Andrewe Baca, Alexander C. Small, Carina Himes, and Dima Raskolnikov Ryan CookRyan Cook , Andrewe BacaAndrewe Baca , Alexander C. SmallAlexander C. Small , Carina HimesCarina Himes , and Dima RaskolnikovDima Raskolnikov View All Author Informationhttps://doi.org/10.1097/01.JU.0001008860.46052.c4.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urologists face increasing pressure to perform outpatient surgeries within Ambulatory Surgery Centers (ASCs) rather than hospitals. However, few guidelines exist to help urologists and institutions determine which patients are at an acceptable medical risk for this care setting. We retrospectively reviewed medically high-risk patients who underwent ureteroscopy within an ASC to determine rates of unplanned healthcare encounters in the acute postoperative setting. METHODS: We reviewed 100 consecutive patients who underwent ureteroscopy for the treatment of kidney stones at a free-standing, ASC affiliated with an urban academic medical center. Patients were included if their American Society of Anesthesiologists (ASA) score was ≥3, meaning there was at least one serious condition impacting their overall health. Records were reviewed for peri-operative complications requiring emergent transfer from the ASC to an inpatient facility, as well as complications within 30-days. Perioperative risk was assessed using Charlson Comorbidity Index (CCI) and the 5-factor Modified Frailty Index (mFI-5). CCI was stratified as mild (0-2), significant (3-4), or high (5+) risk. The mFI-5 was stratified as mild (0-3) or high (3+) risk. RESULTS: The 100 patients had a mean age of 60 years (SD 13.3) and mean BMI 31.8 (SD 7.1). The most common chronic illnesses were hypertension (74%), COPD (44%), diabetes (40%), peripheral vascular disease (14%), and liver disease (13%). By CCI, most patients were either high (28%) or significant (23%) risk, with median score 3 (IQR 1-5). By mFI-5, 20% of patients were high risk. No patient required emergent post-operative transfer to an inpatient facility. In the 30 days postoperatively, 15 patients presented to the Emergency Department (ED) for evaluation and 5 patients were admitted. 12 of these 15 patients presented with urological complaints. Using multivariate logistic regression, the mFI-5 and CCI were not predictive of post-operative ED visit (Table 1). CONCLUSIONS: Selected high-risk patients with unfavorable ASA, mFI-5, and CCI scores who undergo elective ureteroscopy within an ASC are unlikely to require emergent, post-operative transfer to an inpatient facility. Further research is necessary to explore ASC-appropriateness criteria that may help to expand surgical access. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e399 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ryan Cook More articles by this author Andrewe Baca More articles by this author Alexander C. Small More articles by this author Carina Himes More articles by this author Dima Raskolnikov More articles by this author Expand All Advertisement PDF downloadLoading ...