Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts MP2-15 Disparities in Time to Definitive Stone Surgery at a Major, Urban, Academic Healthcare System E. Nivasch Turner 1 ; R. Talwar 1 ; O. Familusi 2 ; R. Kovell 1 ; T. Guzzo 1 ; J. Ziemba 1 1 Hospital of University of Pennsylvania, Philadelphia, PA, USA; 2 Perelman School of Medicine, Philadelphia, PA, USA Introduction: Disparities in nephrolithiasis care based on gender and ethnicity have been described. Fewer studies have examined insurance status. Recent data suggests longer surgical wait times for patients without private insurance. We conducted a self-audit to assess effects of ethnicity and insurance on time to kidney stone surgery. Materials & Methods: We retrospectively assessed patients with evaluation of nephrolithiasis in the emergency room (ED), followed by definitive surgery (ureteroscopy/percutaneous nephrolithotomy/ESWL) at ourmajor academic health system consisting of 3 hospitals in a major city, collecting information regarding insurance status and various demographic/clinical factors. Results: In total, 601 patients underwent ED evaluation followed by surgery from 2017-2020. Overall, 3.5% (n = 23) were uninsured, 4.3% (n = 282) were enrolled in federal healthcare (Medicare/Medicaid), and 54% (n=355) had private healthcare. Table 1 illustrates cohort characteristics. Median time to surgery overall was 36 days. Uninsured patients had a shorter time to surgery (median 20 days, p = 0.023). Private insurance was associated with lower rates of UTI (p = 0.035) and sepsis (p = 0.036). Patients with private insurance were more likely to be discharged from the ER (p = 0.031). African American ethnicity was associated with longer time to surgery (Table 2, p < 0.001), as well as stent placement upon ER presentation (p = 0.05). Conclusions: In our study, privately insured patients have lower acuity presentations without concurrent UTI/sepsis, requiring fewer urgent interventions and/or admissions. Higher acuity/delayed presentations may explain shorter times to surgery for uninsured patients and higher rates of ED stenting for African Americans. Differential access to care may explain time to surgery disparities based on ethnicity vs. insurance status. Management of Urologic Conditions at a Regional Referral Center for Bloodless Medicine and Surgery A. Wood; B. Shpeen; W. Plath; A. Schulman Maimonides Medical Center, Brooklyn, NY, USA Introduction: Bloodless Medicine & Surgery is an organized program to provide effective care while respecting patient values. In this study, we reviewed the management of elective and urgent Urologic conditions at a regional referral center for Bloodless Medicine and Surgery. Materials &Methods: We performed a retrospective review of Bloodless Medicine & Surgery patients admitted to the Urology service between 2013 and 2019. Cases were categorized as elective procedures or unplanned emergent admissions and the procedural interventions and bloodless strategies were examined. Hemoglobin values, estimated blood loss, critical care stay, total length of stay and complications were recorded. Results: There were a total of 44 admissions to the Urology service. Median age was 65 and included 28 (64%) males and 16 (36%) females. 23 had elective surgeries including 14 laparoscopic procedures, 6 endoscopies and 3 open surgeries. Mean EBL was 61.9 ml. Complications were observed in 5 patients including one death from a perforated duodenal ulcer. 21 patients were admitted urgently, including 15 with symptomatic bleeding and 10 transfers fromother hospitals. Mean hemoglobin on admission was 8.9 (range 2.9-13.4). The Bloodless Medicine teamwas consulted in all cases of acute bleeding. 9 patients received iron supplementation and 8 were treated with darbopoeitin. 16 patients had a procedure including 4 nephrostomy diversion, 2 angioembolization and 5 endoscopic fulguration. Mean LOS was 5.2 days. Mean Discharge hemoglobin was 7.4 (range 3.4 to 13.3). Conclusions: Bloodless Medicine & Surgery is feasible for both elective and urgent Urologic conditions. A multidisciplinary approach incorporating a dedicated ‘on call’ team and judicious procedural interventions provides safe patient care while respecting patient values. MP2-14 25 Poster Session 2: Urologic Best Practices