Minimal Inpatient Narcotic Requirement and Immediate Complication Profile Supports Same-day Discharge Following Artificial Urinary Sphincter Insertion

Introduction: With more than 3,500 artificial urinary sphincters placed annually in the United States a significant cost burden is associated with overnight observation following surgery. We sought to determine whether inpatient management after artificial urinary sphincter insertion, our current local standard of care, is necessary with regards to inpatient narcotic requirements and immediate postoperative complications. Methods: This was an institutional review board approved, retrospective review of artificial urinary sphincter insertions identified by CPT code 53445 between June 2013 and September 2017. Medical records were reviewed for patient demographics, postoperative narcotic use and immediate postoperative complications. Results: We identified 163 men who underwent artificial urinary sphincter insertion for analysis. The cohort had a mean age of 69.8 +/- 8.5 years, body mass index of 28.9 +/- 5.1 kg/m(2) and preoperative pad per day use of 5.8 +/- 3.5. Of all patients identified 25 (15%) were using chronic narcotic pain medication preoperatively and 51 (31%) had a diagnosis of diabetes (mean A1c 7.0 +/- 1.5%). All but 1 (99%) patients were discharged on the first postoperative day and 1 left on the second postoperative day. Two (1.2%) patients experienced immediate postoperative complication, and 8 (6%) patients failed a voiding trial on postoperative day 1. The 154 (94%) patients who required orally administrated narcotic pain medication after leaving the postanesthesia care unit used a median of 31.0 +/- 22.9 morphine milligram equivalents. Conclusions: Immediate postoperative and peridischarge complication rates are around 1% after artificial urinary sphincter insertion, and narcotic requirements following postanesthesia care unit stay are minimal. Outpatient artificial urinary sphincter insertion is likely to be safe, effective and beneficial with regards to patient experience and total costs.