Abstracts from the New England Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 Scientific Session I: Oncology I Clinical Utility of Routine Overnight Vital Signs in Patients Undergoing Cystectomy JeffreyM. Howard, MD, PhD , Solomon L. Woldu, MD, VitalyMargulis, MD University of Texas Southwestern Medical Center, Dallas, TX, USA Introduction: Obtaining vital signs every four hours, including the overnight period, is routine practice in patients hospitalized after major surgery. However, increasing attention has been drawn to patient sleep disruption as a potential contributor to impaired recovery, hospital delirium, and patient dissatisfaction. We sought to assess whether routine overnight vital signs (as opposed to those obtained for a clinical indication) led to the diagnosis of serious conditions that would otherwise have been missed. Materials & Methods: Using the electronic medical record, we obtained all vital signs obtained on postoperative days (POD) 0 through 6 of all patients undergoing cystectomy at our institution between January 2016 andDecember 2020 (a period of five years). The data were filtered to identify complete sets of vital signs obtained between the hours of 22:00 and 05:30, inclusive. Sets of vital signs were then flagged as “abnormal” based on parameters that would generally have prompted a call to the patient’s responding clinician (temperature ≥ 101.0°F or < 95.0°F, pulse < 50 or > 120 bpm, systolic blood pressure < 85 or ≥ 190 mmHg, respirations ≤ 8 or ≥ 22/min, oxygen saturation < 90%). The primary outcome was the degree of intervention, if any, prompted by the abnormal vital signs as determined by chart review. Interventions were categorized as none (event judged clinically insignificant, or intervention was already under way), minor (administration of IV fluids, antipyretics, reordering a patient’s home medications, etc.), moderate (antibiotics, blood/ urine cultures, imaging studies), or major (ICU transfer or reoperation). Results: Our search criteria captured a total of 754 patients with 22,382 complete sets of vital signs representing 4,701 patient-nights in the hospital. Of the complete sets of vital signs, 6,920 were obtained between the hours of 22:00 and 05:30. Of these, we identified a total of 47 unique cases of abnormal vital signs reflecting a new change in the patient’s status during the overnight period. Most of these cases (24/47, 51%) were deemed clinically insignificant, while 11/47 (23%) prompted a minor intervention, 7/47 (15%) a moderate intervention, and 5/47 (11%) a major intervention. Thus, a total of 12 new- onset clinical events prompting a moderate or major intervention occurred over a total of 4,701 patient-nights in the hospital, a rate of 0.26%. Subjectively, most adverse events reviewed were associated with additional signs or symptoms that would likely have prompted evaluation independently of the abnormal vital signs. Conclusions: The rate at which routine overnight vital signs (as opposed to those obtained for a specific clinical indication) leads to the diagnosis of a new adverse clinical event is very low. Consideration should be given to omitting routine overnight vitals in stable, uncomplicated patients undergoing cystectomy. We are currently undertaking additional analyses to identify low- and high-risk groups for adverse events and to quantify the costs and benefits of omitting routine overnight vital signs. RadicalCystectomyinaBubble:CatchingAllComplicationsandReadmissions Joshua A. Linscott, MD, PhD , Randie E. White, MD, Stephen T. Ryan, MD, Moritz H. Hansen, MD, Jesse D. Sammon, DO, Matthew H. Hayn, MD Maine Medical Center, Portland, ME, USA Introduction: Radical cystectomy (RC) is a highly morbid procedure with frequent complications and readmissions. Our institution is the only academic center in state and provides a vast majority of cystectomy care. A large integrated health network, EMRs, and a statewide health information exchange (HIE) make hospitalization and outpatient records readily available to us. Here we report adverse advents after RC for all patients from 2015-2019 with detailed 90d results available for every patient. Materials & Methods: A single institution, prospectively maintained database identified 159 consecutive patients who underwent RC from 2015- 2019. Complications were graded and classified by the MSKCC system. Complications and readmissions occurring statewide for 90d after surgery were recorded and analyzed. Univariable andmultivariable logistic regression analyses were conducted for all complications, high grade complications, and readmission. Results: For 159 consecutive patients, 90d follow up was available for 100% of patients and long-term follow-up was available for 101/104 (97.9%) of living patients. Patient demographics are shown in table 1. For patients with ≥ cT2 disease at diagnosis 58/112 (60.7%) received neoadjuvant chemotherapy. Overall, 292 complications were recorded with 79.8%, 13.0%, and 7.2% occurring by 30d, 60d, and 90d, respectively. Individual patient highest complication grades were 0, 1, 2, 3, 4, & 5 occurring at 21.4%, 15.7%, 34.0%, 18.9%, 7.5%, and 2.5% respectively. Readmission rate was 38.4% (61/159) at a median time of 10.0 days after discharge with 22/61 (36.1%) having a diagnosis of infection related to GU source. On multivariable analysis, risk factors for any complication were Age, EBL, ASA, and intraoperative transfusion (p <0.05). No risk factors were identified for high grade complications or readmission. Conclusions: Our types of complications (class and grade) are comparable to many large series. By incorporating outside hospital EHR, however, we noted higher than expected complication and readmission rates (78.6% & 38.4%, respectively). We believe capturing complications and readmissions statewide (up to 5 hr+ travel radius) allowed for increased detection of adverse events. This data will guide prospective studies aimed at improving patient care for a large rural state. 6 5 4