Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts Increased Healthcare Utilization in the Year Following Non-Muscle Invasive Bladder Cancer Diagnosis Among Older Adults with Multiple Chronic Conditions J. Kashkoush; A. Berger; A. Park; H.L. Kirchner; T. Garg Geisinger, Danville, PA, USA Introduction: Two-thirds of older adults with cancer have multiple chronic conditions (MCC). Non-muscle invasive bladder cancer (NMIBC) is a burdensome chronic condition in older adults, requiring frequent outpatient visits and surgery. Frequent healthcare visits may not align with the goals of medically complex older cancer patients, but little is known about howNMIBC diagnosis impacts healthcare utilization. The objective was to describe healthcare utilization following NMIBC diagnosis by MCC status. Materials &Methods: We included older NMIBC patients (age ≥ 60, stage < II) from 2003-2015. Healthcare utilization included outpatient, inpatient, and emergency department visits. Multiple visits on the same day counted as one contact day. AHRQ Clinical Classifications Software and Chronic Condition Indicator were applied to diagnosis codes to identify chronic conditions. MCCwas defined as two or more chronic conditions. We estimated the difference in healthcare utilization pre- and post-NMIBC diagnosis using a multivariable linear regression model adjusted for age and prior cancer. Results: Of 317 NMIBC patients, 263 (83%) had MCC. MCC patients were older (74 years versus 68.6 years), had prior cancers (29.7% versus 14.8%), and had more prescribed medications (7 versus 2). Patients with both NMIBC and MCC had higher utilization before diagnosis (14 days versus 2 days). Patients without MCC had a larger change in utilization after NMIBC diagnosis compared to those with MCC (13.9 days versus 7.5 days). In multivariable analysis, patients without MCC had 6.23 more contact days than those with MCC (95% CI 1.34-11.12, p = 0.01). Conclusions: Older adults without MCC had larger increases in healthcare utilization following NMIBC diagnosis than those without MCC. Adding a new chronic condition like NMIBC compounds healthcare utilization in older adults. These data may serve as a baseline for future studies to reduce burdens related to NMIBC diagnosis and treatment in medically complex older adults. MP4-05 The Use of Postoperative Loopogram in Predicting 90-day Readmission for Ureteroenteric Stricture C. Yeaman; K. Maciolek; P. Nelson; C. Morris; T. Krupski University of Virginia, Charlottesville, VA, USA Introduction: Ureteroenteric stricture incidence has been reported as high as 20% after urinary diversion. There is no consensus for management of urinary diversion postoperatively. Loopogram is an inexpensive modality to evaluate ureteroenteric anastomoses in urinary diversion. We hypothesized that failure to reflux is associated with clinically meaningful stricture. Readmission diagnoses including pyelonephritis, acute kidney injury, and hydronephrosis were considered related to ureteroenteric stricture. Materials &Methods: IRB approved cystectomy database was utilized to identify ureteroenteric strictures from 201 patients who underwent urinary diversion at a single academic center between 2016 and 2020. 35 underwent urinary diversion for benign pathology and 166 for malignancy (182 ileal conduit, 7 neobladder, 12 Indiana pouch), all with refluxing anastomoses. We categorized patients postoperatively with or without loopogram and loopogram findings of no, unilateral, or bilateral reflux. Postoperative imaging was determined by provider preference. To identify patients with strictures, related readmission diagnoses were queried: pyelonephritis, AKI, and hydronephrosis within 90 days. Further chart review was conducted to determine the presence of confirmed stricture in these patients, defined as endoscopic diagnosis or definitive imaging findings. Results: Overall readmission rate was 41% (83/201), potential stricture-related readmission was 24% (49/201). Loopogram was performed at a median of 31 days postoperatively.StrictureandreadmissionresultsareshowninTable1.Higherstricture rateswereassociatedwithunilateralandnoreflux(notstatisticallysignificant).PPVand NPVofloopogramtoidentifyureteroentericstricturewere22.8%and93%,respectively. Conclusions: Our study suggests degree of reflux does not reliably predict postoperative readmission or ureteroenteric stricture. Lack of reflux is not specific for ipsilateral ureteroenteric stricture. Increased stricture rate in loopogram cohort may be due to providers performing loopogram in high risk patients. MP4-03 Poster Session 4: Oncology Treatment and Outcomes 31 MP4-04 MP4-07 Association Between Preoperative Internal Medicine Optimization and 30-Day Outcomes Following Transurethral Resection of Bladder Tumors inOlder Adults R. Keller 1 ; K. Hartman 2 ; A. Young 1 ; K. Kost 1 ; M. Lentz 1 ; T. Morland 1 ; M. Meissner 1 ; T. Garg 1 1 Geisinger, Danville, PA, USA; 2 University of Florida, Jacksonville, FL, USA Introduction: Preoperative optimization reduces complications following major surgery; however, data suggest no benefit for low-risk procedures. Transurethral resection of bladder tumor (TURBT) is a low-risk procedure performed under general anesthesia in older adults whomay benefit fromoptimization. Our objective was to evaluate the association between preoperative optimization and 30-day outcomes following TURBT in older adults. Materials&Methods: We identified686patients(≥60years)whounderwentTURBT from2005-2017.ApreoperativeoptimizationclinicwasestablishedinJuly2014.Group 1 (n = 197) included TURBT patients before July 2014. Group 2 (n = 154) included patients who received optimization after July 2014. Group 3 (n = 335) included those who did not undergo optimization after July 2014. Primary outcomes were 30-day emergency room (ER) visits and readmissions. Groups 1 and 2 werematched on age, sex, and Charlson comorbidity index (CCI). Matched logistic regression was used to model the association between preoperative optimization and 30-day outcomes, while adjusting for variables significant on univariate analysis. Results: Patients receiving optimization were older (mean 76.7 years), had higher CCI, and longer surgery time (59 minutes). Groups 1, 2, and 3 each had 35, 48, and 29 ER visits (p = 0.57). Groups 1, 2, and 3 had 7, 31, and 16 readmissions within 30 days (p = 0.01). In matched multivariable logistic regression, we found no difference in the odds of 30-day ER visits (adjusted OR 1.03, 95% CI 0.53-2.01) and readmissions (adjusted OR 2.60, 95%CI 0.87-7.79). Conclusions: InthisstudyofolderadultsundergoingTURBT,wefoundnodifference in 30-day outcomes when comparing thosewho did and did not receive preoperative optimization. This retrospective study was not designed with power to detect differences; however, these data may inform future studies to design preoperative care that optimizes outcomes for older adults undergoing low risk surgery. Active Surveillance and Delayed Intervention for Small Renal Masses in Young Patients M. Metcalf; J. Cheaib; M. Biles; H. Patel; P. Pierorazio Johns Hopkins Medicine, Baltimore, MD, USA Introduction: The incidence of renal cell carcinoma has increased over the past several decades, along with a stage migration. An accompanying paradigm shift in the management of small renal masses (SRMs) has increased utilization of active surveillance (AS). However, questions remain regarding the safety and durability in younger patients. Materials & Methods: Patients 60 years old or younger at diagnosis were identified from the Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry, a prospective, multi-institutional study comparingAS to primary intervention (PI). The PI,AS, and delayed intervention (DI) groups were evaluated usingANOVAwith Bonferroni correction, χ2 and Fisher’s exact tests, and Kruskal- Wallis and Wilcoxon signed-rank tests. Survival outcomes were calculated using the Kaplan-Meier method and compared with the log-rank test. Results: Of 224 patients aged 60 years or less with follow up available, 156 (69.6%) chose PI and 68 (30.4%) chose AS, with median follow up of 4.9 years. A total of 20 patients (29.4%) experienced a progression event, and 13 (19.1%) underwent DI. Among patients with initial tumor size ≤ 2 cm, 15.1% crossed over to DI, compared to 33.3% with initial tumor size 2-4 cm. Overall survival was similar in patients undergoing PI as compared to AS up to 7 years (94.0% vs. 90.8%, log-rank P = 0.2). There were no significant differences between PI and DI with respect to minimally invasive or nephron-sparing interventions or pathological findings. Recurrence-free survival after intervention at 5 years was 96.0% and 100% for PI and DI, respectively (log-rank P = 0.6). Conclusions: AS is a safe initial strategy in younger patients and can avoid unnecessary intervention in the subset with benign biology for whomAS is durable. Crucially, an initial period of active surveillance did not limit treatment options for DI in those whose tumors grew or who opted for elective intervention, and oncologic outcomes weren’t compromised