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Effect of Surgeon and Facility Volume on Outcomes of Benign Prostatic Hyperplasia Surgery: Implications of Disparities in Access to Care at High-Volume Centers.
Nguyen, David-Dan; Bouhadana, David; Murad, Liam; Stoddard, Michelina; Zheng, Xinyan; Mao, Jialin; Zorn, Kevin C; Elterman, Dean S; Bhojani, Naeem; Chughtai, Bilal.
Afiliação
  • Nguyen DD; Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
  • Bouhadana D; Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
  • Murad L; Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
  • Stoddard M; Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
  • Zheng X; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY.
  • Mao J; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY.
  • Zorn KC; Division of Urology, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
  • Elterman DS; Division of Urology, Department of Surgery, University Health Network (UHN), Toronto, Ontario, Canada.
  • Bhojani N; Division of Urology, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
  • Chughtai B; Department of Urology, Weill Cornell Medical College/New York-Presbyterian, New York, NY. Electronic address: bic9008@med.cornell.edu.
Urology ; 172: 97-104, 2023 02.
Article em En | MEDLINE | ID: mdl-36410527
OBJECTIVE: To report the effect of surgeon and facility volume on outcomes of transurethral resection of the prostate (TURP) and laser treatment of benign prostatic hyperplasia (BPH). We also investigate disparities in access to care by identifying demographic predictors of receipt of treatment at high-volume facilities. METHODS: We used New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) data. We included 18,041 (41.4%) and 25,577 (58.6%) adult patients that underwent TURP and laser procedures in the outpatient setting between January 2005 and December 2018, respectively. Average annual surgeon and facility volumes were broken down by tertile. The effect of volume on short-term outcomes (30-day and 90-day readmission) was examined using mixed-effect logistic regression models. Cox-proportional-hazard models were used to assess the association between volume and long-term stricture development and reoperation. Demographic predictors of treatment at high-volume facilities were assessed using multinomial logistic regression. RESULTS: High-volume facilities were more likely to offer laser procedures compared to low-volume facilities. Higher facility and surgeon volume were associated with lower odds of 30 and 90-day readmissions compared to low-volume facilities. There was no difference in reoperation and stricture development between surgeon volume groups. Medicaid insurance, Hispanic ethnicity, and Black race were inversely associated with treatment at high-volume facilities. CONCLUSION: Higher surgeon and facility volumes were associated with lower odds of readmission. Higher facility volume was associated with lower hazards of reoperation and developing strictures. Medicaid insurance and non-white race were associated with lower odds of treatment at high-volume facilities, highlighting racial and socioeconomic disparities in access to high-volume BPH surgery facilities.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Hiperplasia Prostática / Ressecção Transuretral da Próstata / Cirurgiões Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Hiperplasia Prostática / Ressecção Transuretral da Próstata / Cirurgiões Idioma: En Ano de publicação: 2023 Tipo de documento: Article