No abstract

INTRODUCTION AND OBJECTIVE: Venous thromboembolism (VTE) is a perioperative complication with significant morbidity. Routine use of peri-operative VTE prophylaxis is common guideline-driven practice across multiple surgical specialties. There is a discrepancy between guideline recommendations and clinical practice in the administration of peri-operative heparin for anterior urethroplasty. The purpose of this study was to examine the necessity of peri-operative heparin in patients undergoing anterior urethroplasty.METHODS: Patients were identified from an IRB-approved, prospectively maintained database of patients undergoing anterior urethral reconstruction by a single surgeon at MedStar Washington Hospital Center (MWHC) from 2012-2020. All patients had sequential compression devices (SCDs) prior to anesthesia induction. Patients received heparin based on hospital policy as dual prophylaxis. Primary endpoint was perioperative VTE within 30 days with secondary outcomes of peri-operative complications and stricture recurrence.RESULTS: We identified 342 patients who met inclusion criteria. 68 patients received peri-operative heparin. One patient had a DVT in the SCD only group. There were statistically significant increases in hospital length of stay, stricture recurrence, and postoperative complications in the group that received heparin.CONCLUSIONS: Routine heparin administration likely overtreats men undergoing anterior urethroplasty. There may be a subset of men in whom dual prophylaxis with heparin and SCD is beneficial for prevention of VTE. Currently guidelines do not offer adequate criteria to identify these men. We offer an algorithm to help guide further study to identify these patients.

No abstract

between 2004 to 2019 with resident involvement. The cases were stratified by resident involvement: attending as primary (AP), attending and resident (AR), resident as primary (RP).RESULTS: 127,757 urology cases were identified from 2004 to 2019. The most frequent surgeries were transurethral resection of prostate (TURP); transurethral resection of small, medium, or large tumor (TURBT); GreenLight laser of prostate (GLL); hydrocelectomy; and ureteral stent placement. These procedures accounted for 76.5% of all cases. The percentage of RP cases decreased from 31.3% of cases to 18.6%. Reduction in RP cases was seen in all seven top urology cases, particularly in ureteral stent placement which has declined from 44% RP in 2004 to 18% in 2019. Cases with resident involvement had patients with more cardiovascular, pulmonary, and infectious comorbidities. Mean operative times in all cases were not significantly different. The 30-day composite complications and 30-day return to operating room were greatest for AR. Postoperative complications of bleeding, infection, DVT, embolism, renal failure, wound dehiscence, and 30 day all-cause mortality were not significantly different.CONCLUSIONS: Urology resident autonomy has decreased within the VA healthcare system over the past 15 years. Mean operative times and postoperative complications are not inferior in cases that involve residents as the primary surgeon. Increased focus on resident education and surgical autonomy in the operating theater is vital for training the next generation of surgeons.

No abstract