AUTHOR REPLY

Thank you very much for your insightful comments on our manuscript. Indeed, we recognize the limitations of the NSQIP database. Clearly, we cannot differentiate those patients with an overnight observation compared to those that were discharged on the same day of Artificial Urinary Sphincter (AUS) implantation. On a population level, utilizing claims-based data may enable this analysis, and better characterize these practice patterns as well as the safety and potential cost savings of same day AUS surgery.  Dropkin et al, from Vanderbilt University, recently published their experience with pain requirements and perioperative complications among 163 patients undergoing AUS insertion, with 162 patients discharged home on the first postoperative day. The potential barriers to same day discharge are related to pain control, additional antibiotic administration, and need for a voiding trial. However, in this retrospective analysis, the authors identified minimal intravenous narcotic requirements, less than morphine milligram (mg) equivalent in 5mg of Oxycodone tablet, and 6.3% patients failing a voiding trial. Furthermore, they demonstrate very low rates postoperative complications occurring within 48 hours of discharge, with 2 patients seen in the emergency room within 48 hours. These authors conclude same-day discharge is potentially safe and cost effective, as a result of poor evidence for additional IV antibiotics, low IV narcotic usage, low complication rates, and 94.7% patients able to void after catheter removal. Weinberg et al reported on the outcomes of same-day inflatable penile prosthesis surgery, reporting on 674 penile prosthesis performed as an outpatient surgery in an Ambulatory Surgery Center. The authors found noninferior rates of complications compared to overnight hospitalization, 3 patients (0.45%) required transfer to hospital from the surgery center, 2 for respiratory distress and 1 for poorly controlled pain. While our health care system stresses high quality care and patient safety, it places a significant emphasis on reducing the cost of health care in the United States. We continue to observe a growing list of urologic surgeries that once required hospitalization, including urethroplasty, that are increasingly performed with same-day discharge while maintaining excellent outcomes and safe patient care. As a result of the above evidence and experience, our practice has evolved and a vast majority of AUS patients are safely discharged home on the same day after passing a voiding trial. Additional larger-scale studies are needed to further support these changing practice patterns in Reconstructive Urology.