Experts discuss trends in complications with minimally invasive urologic surgery

In this video, Matthew Epstein, MD, and Andres F. Correa, MD, share notable findings from the study, “Balancing patient safety and early post-operative discharge: An ACS-NSQIP analysis of post-operative complications after minimally invasive urologic surgery.” Epstein is currently a chief urology resident at Temple University Hospital, and Correa is an assistant professor of urology at Fox Chase Cancer Center in Philadelphia, Pennsylvania.

Video Transcript:

Epstein: I would say the findings were somewhat expected. Most complications that happened, they happened within the first 48 hours postoperatively. Blood transfusions were by far the biggest contributor to this. About 93% of all blood transfusions occurred within the first 48 hours. Second was [myocardial infarctions] MIs; about half of all MIs occurred within the first few days postoperatively. This underlies some of the concern in implementing a more blanket same-day discharge policy in that a short observation period could potentially identify a significant number of patients who can benefit from some type of early identification and intervention from these complications. There's good evidence that shows that untreated anemia, if it's left untreated, there's much higher associated rates of morbidity and mortality, especially in patients who have higher cardiovascular risks. The benefits of early detection intervention for acute coronary syndrome, for example, are pretty well established as well.

Correa: And I think that just giving some background on how we got the data, so this was a review of the National Surgical Quality Improvement Database. That's in a way, a database that gets collected as part of a program for hospitals to be able to track the quality outcomes. The hospitals choose which procedures they want to follow, and they get some information and feedback about how they're doing. They get benchmarks across different hospitals regarding how much people they're taking, tertiary versus level 2 hospitals, and stuff like that. So, this database was created for hospitals to be able to track their own quality outcomes. The nice thing about being able to track this is that they do a very good job about tracking how patients are doing from a complication standpoint, throughout the patient's recovery. From that part of the database, we actually were able to get very granular collection about when these events happened and what events are occurring.

The thing that we're having trouble collecting is the granular data that Matt talked about is the fact that how these patients were doing in the pre-op holding area and what led to the complication. That data we don't have as part of this database, so we're guessing a little bit if these patients potentially would have been a patient that someone that is practicing same-day surgery would have said, "No, I want to keep this patient back." We don't know that. So I think that this is just to an idea out there that, "Hey, this actually does occur." These bad events can happen and typically happens on post op day 1, post op day 2. And those patients if at home, could potentially have a fatal event because those patients will not be having the regular monitoring that they will have in the hospital.

We are a little bit limited in how much we can deduce about how safe the program can be. The main thing here is just to raise awareness, that although this procedure has become very ubiquitous and a lot of places are doing it and is overall safe, complications do occur. I think that it is important to think about what are we treating here? Are we treating prostate cancer? The reason we treat prostate cancer is for someone not to die of that disease 10-15 years down the road. So, having a fatality or someone have a bad event associated with this procedure is a tremendous mess. Because when you're trying to give this guy 10 years of life, so if you have someone die post-operatively, that to some degree, you completely abolish any kind of meaningful benefit you are giving to that patient. For these patients, when you're trying to get them to live 10-15 years longer by doing this procedure, you really must make sure that this post-op recovery occurs in the in the most beneficial way to the patient and the safest way possible.

This transcription has been edited for clarity.