You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy II (MP76)1 May 2024MP76-13 IDENTIFYING RISK FACTORS FOR INCREASED HEALTHCARE UTILIZATION FOLLOWING IPP PLACEMENT Roger D. Klein, Sherry L. Huang, John Myrga, William Daly, and Paul J. Rusilko Roger D. KleinRoger D. Klein , Sherry L. HuangSherry L. Huang , John MyrgaJohn Myrga , William DalyWilliam Daly , and Paul J. RusilkoPaul J. Rusilko View All Author Informationhttps://doi.org/10.1097/01.JU.0001009484.98400.42.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous studies have demonstrated increased rates of postoperative healthcare utilization in patients with a preoperative diagnosis of a chronic pain and/or psychiatric condition. Preoperative counselling and referral for specialist support prior to elective surgery can outline expectations regarding postsurgical recovery and decrease burden on providers' outpatient clinics. Herein, we seek to quantify healthcare utilization rates following inflatable penile prosthesis (IPP) placement and determine if an existing chronic pain and/or psychiatric diagnosis affects the frequency of healthcare system interaction. METHODS: We performed a retrospective chart review of 128 patients who underwent placement of a three-piece inflatable penile prosthesis with a single surgeon between 2017 and 2023. Age, BMI, distance traveled for surgery, history of a chronic pain condition, preoperative analgesic use, and the presence of a charted psychiatric diagnosis were assessed. All patient phone calls and unscheduled office visits within the first 90 days of discharge were recorded. RESULTS: Patients with a documented chronic pain condition, including neuropathy, arthritis, low back pain, and fibromyalgia were significantly more likely to have an unplanned office visit within 90 days of IPP placement than those who did not (OR 2.10, 95% CI 1.01-4.34, p=0.04). There were no differences in the background demographics of these populations, including age, BMI, or distance traveled for surgery. There was no significant difference in postoperative office visit frequency noted between patients with and without chronic opioid (OR 1.35, 95% CI 0.49-3.77, p=0.56) or nonopioid (OR=0.84, 98% CI 0.41-1.73, p=0.64) analgesic use. There was no significant difference in the frequency of postoperative office calls or visits between patients with a psychiatric diagnosis listed in the electronic medical record and those who did not, although patients with an active psychiatric diagnosis undergoing IPP placement were more likely to be younger (63.9 vs 60.3, p=0.04) and have a lower BMI (29.0 vs 31.3, p=0.04). CONCLUSIONS: A history of a chronic pain condition was associated with an increased likelihood of an unplanned postoperative office visit relative to those who did not report a chronic pain condition. This suggests that these patients may benefit from preoperative counselling and/or chronic pain referral to address their chronic pain prior to elective IPP placement. Source of Funding: None to report © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1247 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Roger D. Klein More articles by this author Sherry L. Huang More articles by this author John Myrga More articles by this author William Daly More articles by this author Paul J. Rusilko More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Surgical Therapy I (MP06)1 Sep 2021MP06-14 USE OF STONE CULTURE ANTIBIOGRAM AND PERI-OPERATIVE RISK FACTORS TO PREDICT SEPSIS FOLLOWING PCNL William Daly, Nathanaelle Ibeziako, Christopher Stockdale, Mitchell Nguyen, Erin Santos, and Johann Ingimarsson William DalyWilliam Daly More articles by this author , Nathanaelle IbeziakoNathanaelle Ibeziako More articles by this author , Christopher StockdaleChristopher Stockdale More articles by this author , Mitchell NguyenMitchell Nguyen More articles by this author , Erin SantosErin Santos More articles by this author , and Johann IngimarssonJohann Ingimarsson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001973.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Risk of sepsis after PCNL is highly correlated with stone culture results. High discordance between bladder urine culture and kidney stone culture calls into question the clinical application of stone cultures. This study sought to determine if an institutional kidney stone antibiogram would help in antibiotic selection and to identify risk factors of sepsis, particularly among those with stones resistant to standard antibiotic approach. METHODS: A retrospective chart review was performed on 207 consecutive patients who underwent PCNL between October 2016 and December 2018. Patient demographics, comorbidities, infection history, culture data, stone factors, and surgical factors were recorded. Patients received culture specific pre-operative antibiotics and peri-operative ampicillin or vancomycin and gentamycin. A stone antibiogram was developed. Sepsis was defined by SIRS criteria. Risk factors for sepsis and resistant stone cultures were analyzed. RESULTS: 65 patients had positive stone cultures. Concordance with pre-operative culture was 31%. Enterococcus (23.9%), yeast (15.2%,), coagulase negative staphylococcus (CONS) (14.1%,), and E. coli (12%) were the most common stone pathogens. 91% of enterococci were sensitive to ampicillin and 95% to vancomycin. All E. coli were sensitive to gentamicin. 58 patients had positive cultures despite having received appropriate antibiotics. 15 patients developed sepsis. Chronic indwelling catheter was the strongest risk factor for sepsis (RR 10.9; p=0.001). 7 of the 15 patients with sepsis had microbes on stone culture resistant to their antibiotic regimen. 4 with candida sp. and 4 with gentamicin resistant gram-negative rods. Chronic indwelling catheters (RR 11.4; p=0.003) and limited mobility (RR 9.5; p<0.001) were the primary risk factors for resistant stone cultures on univariate analysis. CONCLUSIONS: According to our antibiogram, a standardized regimen of peri-operative ampicillin or vancomycin and gentamycin covers the majority of microorganisms found in stone culture and, so, the vast majority of patients. Only 3% of all patients had stone cultures resistant to this regimen and became septic. Patients with chronic indwelling catheters are at a higher risk of sepsis and having resistant microbes, arguing for broader peri-operative antibiotic coverage. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e95-e95 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information William Daly More articles by this author Nathanaelle Ibeziako More articles by this author Christopher Stockdale More articles by this author Mitchell Nguyen More articles by this author Erin Santos More articles by this author Johann Ingimarsson More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making I (MP02)1 Apr 2020MP02-06 CAUSES FOR REFERRAL DELAY IN PATIENTS REQUIRING CYSTECTOMY AT A TERTIARY CARE CENTER Joshua Linscott*, William Daly, Tracy Robbins, Lisa Beaule, Matthew Hayn, Moritz Hansen, Jesse Sammon, and Stephen Ryan Joshua Linscott*Joshua Linscott* More articles by this author , William DalyWilliam Daly More articles by this author , Tracy RobbinsTracy Robbins More articles by this author , Lisa BeauleLisa Beaule More articles by this author , Matthew HaynMatthew Hayn More articles by this author , Moritz HansenMoritz Hansen More articles by this author , Jesse SammonJesse Sammon More articles by this author , and Stephen RyanStephen Ryan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000816.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Delays in treating bladder cancer are an unintentional consequence of regionally centralizing cystectomy care. Our prior work identified barriers to timely cystectomy and led to development of an independent nurse navigator system to mitigate delays. The aim was for all patients to receive treatment within 90 days of diagnosis. Here, we perform follow-up analysis to determine the impact of nurse navigation and identify target areas for further improvement. METHODS: Patients requiring cystectomy for bladder cancer at a tertiary care facility were identified by retrospective review. Dates were recorded for (1) procedure prompting cystectomy, (2) referral to cystectomy provider, (3) consultation, and (4) receipt of treatment (neoadjuvant chemotherapy or cystectomy). Nurse navigation was instituted at the time of consultation. Delay was defined as >90 days from procedure to treatment. Travel time was mapped as minutes in drive time from patient home to facility. Intervening milestones to care were analyzed based on first 10 records, power analysis was estimated (n=50). Wilcoxon analysis compared patient related (travel time) and provider related factors (days to referral). RESULTS: Of the 53 patients reviewed, 18/18 (100%) internal and 30/35 (86%) external regional referrals were treated within 90 days. Time from bladder procedure to cystectomy consultation was longer for external referrals compared to internal referrals [Median (Interquartile Range): 21 days (IQR 17-44) vs. 13 days (IQR 7 – 21), p=<0.001]. Time from procedure to referral order was longer in the external group (13 days, IQR 6-26) compared to the internal group (3 days, IQR 3-4). Interestingly, patients in the upper quartiles of referral delay had shorter travel times to the treatment facility [≥13 days: 40 mins (IQR 31-52)] compared to those referred earlier [<13days: 74 mins (IQR 51-99), p=<0.002]. CONCLUSIONS: Nurse navigation for cystectomy patients resulted in high levels of treatment within 90 days. Patients with external referrals were more likely to experience delays, and notably, delays were more likely to happen in patients living closer to the treatment facility. We suggest nurse navigation earlier in care to help address structural, political, and cultural causes of delays. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e13-e13 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Linscott* More articles by this author William Daly More articles by this author Tracy Robbins More articles by this author Lisa Beaule More articles by this author Matthew Hayn More articles by this author Moritz Hansen More articles by this author Jesse Sammon More articles by this author Stephen Ryan More articles by this author Expand All Advertisement PDF downloadLoading ...

Data for the incidence of acute kidney injury (AKI) related to intravenous contrast administration in the pediatric trauma population are limited. Obtaining a creatinine value before elective CT scans is a relatively accepted standard of care. We sought to determine whether there was any significant difference in the incidence of AKI between severely injured patients who received IV contrast and those who did not. We reviewed data from the trauma registry at our Level I pediatric trauma center. We limited the patients to severely injured pediatric traumas (<15 years old) directly transported from the scene of injury with a creatinine level measured on arrival. Two hundred and eleven patients were included in the study. AKI was defined by the criteria of the AKI Network. We then compared incidence of AKI in those who received a CT scan with IV contrast with those who did not receive IV contrast. The two groups were comparable in age, gender, Glasgow Coma Scale, Injury Severity Score, mean creatinine on arrival, and mean creatinine post-CT scan/arrival. There was no significant difference in AKI between the two. In a subgroup analysis of patients presenting in shock, there was no significant difference in AKI. Our study suggests that IV contrast is not associated with the development of AKI in severely injured pediatric trauma patients. Although obtaining a creatinine value before exposure is ideal, a CT scan with IV contrast in severely injured children should not be delayed to obtain a creatinine value.

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I1 Apr 2016MP01-11 DETECTION OF MALIGNANCY BY HEMATURIA SCREENING IN PATIENTS ON ANTICOAGULATION William Daly, Jefferson Berryman, Millard Henry, Aaron Benham, Shannon Smith, Zoona Sarwar, Julie Stoner, and Jonathan Heinlen William DalyWilliam Daly More articles by this author , Jefferson BerrymanJefferson Berryman More articles by this author , Millard HenryMillard Henry More articles by this author , Aaron BenhamAaron Benham More articles by this author , Shannon SmithShannon Smith More articles by this author , Zoona SarwarZoona Sarwar More articles by this author , Julie StonerJulie Stoner More articles by this author , and Jonathan HeinlenJonathan Heinlen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1841AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hematuria is an important sign of genitourinary malignancy. Cystoscopy and imaging is recommended for all patients over 35 years of age with asymptomatic microscopic hematuria or any patient with gross hematuria. Current guidelines do not address the impact of concomitant anticoagulation on the decision to perform hematuria workup. METHODS Our study is a single institution, multi-practitioner retrospective chart review of patients with hematuria from 7/1/2004-7/1/2014. Exclusion criteria were age younger than 35 at time of screening, prior workup for gross or microscopic hematuria in the preceding 365 days, current gynecological or colorectal malignancy, and prisoner status. We collected information about demographics; diagnosis of gross, microscopic or undetermined hematuria (ICD-9 599.71, 599.72, 599.70, respectively); and the use of any known anticoagulants. Characteristics and findings of imaging were reviewed. Cystoscopy reports (CPT 52000 or 52005) were reviewed for abnormal findings that required a biopsy or abnormal cytological findings from the bladder wash. For individuals with biopsy proven malignancy, we assessed their follow up history for evidence of metastatic disease. RESULTS Of the 623 patients screened, 456 were eligible. Average (standard deviation) age was 61 (13) years, 54% were male, 78% Caucasian, and 16% African American. No anticoagulation was in use for 242 (53%) patients and 141 (31%) had known use of anticoagulation therapy, and the remainder (16%) had an unknown history of anticoagulation therapy. Anticoagulated patients had biopsy proven tumor 22% of the time and non-anticoagulated patients had tumor 8% of the time (p<0.005); the odds of tumor remained elevated among anticoagulated patients after adjustment for age and gender (odds ratio 2.58, 95% CI: 0.98 to 6.81, p=0.055). CONCLUSIONS Evaluation for hematuria should not be withheld on the basis that the patient is anticoagulated. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e5 Advertisement Copyright & Permissions© 2016MetricsAuthor Information William Daly More articles by this author Jefferson Berryman More articles by this author Millard Henry More articles by this author Aaron Benham More articles by this author Shannon Smith More articles by this author Zoona Sarwar More articles by this author Julie Stoner More articles by this author Jonathan Heinlen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...