Ureteroscopy at ambulatory surgery centers can be safe for select high-risk patients
Ryan Cook1, Andrewe L Baca2, Alexander Small2
1Albert Einstein College of Medicine, 1945 Eastchester Road, Bronx, NY, USA.
Purpose:
To determine whether unhealthy patients undergoing ureteroscopy at an ambulatory surgery center are at high risk of emergency post-operative transfer to an inpatient setting.
Methods:
Records of 100 consecutive high-risk patients undergoing URS at a free-standing ambulatory surgery center (ASC) were reviewed. Patients were considered high-risk if their American Society of Anesthesiologists score (ASA) was ≥ 3. Perioperative risk was assessed using the Charlson Comorbidity Index (CCI) and the 5-factor Modified Frailty Index (mFI-5). Post-operative complications requiring emergent inpatient transfer on the day of surgery and complications within 30-days were recorded.
Results:
The median age for patients was 61.4 years (IQR: 54.7-68.4) and median BMI was 31.0 (IQR: 26.6-37.2). Common chronic illnesses were hypertension (74%), COPD (44%), diabetes (40%), and peripheral vascular disease (14%). All patients were considered high-risk by ASA score. By CCI, 28% of patients were high-risk, 23% were significant risk and 49% were mild risk, with median score of 3 (IQR 1-5). By mFI-5, 20% of patients were high-risk, with median score of 2 (IQR 1-2). No patient required emergent transfer on the day of surgery. Within 30 days postoperatively, 15 patients presented to the Emergency Department (ED) and 5 were admitted. mFI-5 and CCI were not predictive of ED visits.
Conclusion:
Selected high-risk patients with unfavorable ASA, mFI-5, and CCI undergoing URS within an ASC are unlikely to require emergent, post-operative transfer to an inpatient facility.
