Abstracts from the New England Section of the AUA 2021

NE-AUA 2021 Abstracts Scientific Session VI: General Urology, Clinical Practice and Academics Antibiotic Prophylaxis Prior to Outpatient Urologic Procedures: Outcomes From a Department-Wide Quality Improvement Project Matthew B. Buck, BS , Justin Nguyen, MD, Alejandro Abello, MD, Michael S. Leapman, MD, Jaime A. Cavallo, MD, MPHS, Patrick A. Kenney, MD Yale University School of Medicine, New Haven, CT, USA Introduction: Urinary tract infections (UTI) are a common complication following office-based lower urinary tract procedures. While the American UrologicalAssociationBest Practice Statement provides guidelines on antibiotic prophylaxis in this setting, significant variability remains in practice. We assessed the effects of operationalizing a standardized approach to antibiotic use for outpatient lower tract procedures through a nursing-driven algorithm. Materials & Methods: In February 2019, we implemented a clinical decision-support algorithm based on the Best Practice Statement within a regional healthcare network including five practice sites across two states. Covered procedures were outpatient cystourethroscopies with or without manipulation and urodynamic testing. Antibiotic selection was based on an algorithm consisting of established patient risk factors. Nursing staff assessed risk factors and administered single dose 3g oral fosfomycin for eligible patients. We evaluated the impact of our protocol in reducing site-level variation in antibiotic use, abnormal urinalysis, and rates of UTI. Results: 12,909 patients were seen from January 2018 to December 2020, with 7,711 falling under the antibiotic protocol. We observed a reduction in the variation of antibiotic administration post-protocol (difference in SD = -10.55, p < 0.001), accompanied by an overall decrease in antibiotic use rate (- 9.4%, p < 0.001). Changes varied by site, with the pre-intervention highest utilizer experiencing a decrease (absolute percent change – 30.70%, relative percent change - 60.99%) and the lowest utilizer experiencing an increase (absolute percentage change +14.92%, relative percentage change +46.83). Antibiotic use rate changes were not accompanied by a change in abnormal urinalysis (+2.69%, p = 0.437) or urinary tract infection (+0.04%, p = 0.652). Conclusions: Operationalizing a standardized nurse-driven antibiotic prophylaxis pathway for office based cystoscopy reduced practice-level variation in antibiotic administration across a regional healthcare system. Changes in antibiotic practices were not associated with measurable changes in overall rates of UTI. 58 Caprini Score Compliance and Changes in Practice Patterns at an Academic Urological Practice Egor Parkhomenko, MD , Daniel Leslie, MD, Keianna Vogel, BSc, Mark Katz, MD, Shaun Wason, MD, David Wang, MD Boston Medical, Boston, MA, USA Introduction: The Caprini score (CS) accurately predicts those at risk of a venous thromboembolism (VTE) and determines the duration prophylaxis (ppx). The American Urological Association acknowledges high risk individuals and recommends inpatient VTE ppx but fails to provide clear guidelines for outpatient ppx. We sought to assess the practice patterns of urologists prescribing VTE ppx in the post-operative setting for major urological cases after a hospital wide mandate to utilize the CS. Materials &Methods: Aretrospective chart review after institutional review board approval identified patients that had a (robotic, open, or laparoscopic) partial nephrectomy (n = 247) and a (robotic) prostatectomy (n = 317) at an academic medical center from the year 2014-2020. Basic demographic, clinical, operative, and anticoagulation data was collected. Results: Partial nephrectomy patients had a CS of 5.3 (range 2-19), inpatient VTE ppx was used 99% of the time, and readmission rate was 12.6% ( Table 1 ). In 2 years since CS implementation, >50% of patients were assigned a CS, and in 4 years >50% with a CS of >4 received VTE ppx ( Figure 1 ). Prostatectomy patients had a CS of 6.0 (range 1-10), inpatient VTE ppx was used 97.5% of the time, and readmission rate was 2.2%. In 2 years since CS implementation, >50% of patients were assigned a CS, and in 3 years >50% of patients with a CS of >4 received VTE ppx. No correlation was found between VTE ppx for patients with CS >4 and the readmission rates for partial nephrectomy or prostatectomy patients (r= 0.526, p = 0.23 and r= 0.107, p = 0.82, respectively). Conclusions: Compliance with national guidelines for inpatient thromboprophylaxis remains high. The Caprini scoring system takes 4 years after a hospital wide mandate to translate into clinical practice while readmission rates remain stable. 57 29

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