The Utilization and Safety of Same-Day Discharge After Transurethral Benign Prostatic Hyperplasia Surgery: A Case-Control, Matched Analysis of a National Cohort.
Urology
; 165: 59-66, 2022 07.
Article
in En
| MEDLINE
| ID: mdl-35139412
ABSTRACT
OBJECTIVE:
To analyze the utilization and safety of same-day (SDD) vs standard-length discharge (SLD) for transurethral resection (TURP), holmium laser enucleation (HoLEP), and GreenLight photovaporization (GL-PVP) of the prostate.METHODS:
Using the 2015-2019 ACS-NSQIP files, the annual proportion of TURP, HoLEP, and GL-PVP performed with SDD (length of stay [LOS] = 0 days) was calculated. Patients were stratified by LOS into SDD and SLD (TURP LOS = 1-3 days, HoLEP and GL-PVP LOS = 1-2 days); those with longer LOS were excluded. Patients were matched 11 by age, body mass index, American Society of Anesthesiologists score, and modified Charlson Comorbidity Index score. We compared 30-day unplanned readmissions, reoperations, and Clavien-Dindo (CD) complications between SLD and SDD, and evaluated predictors of adverse outcomes using logistic regression.RESULTS:
Most GL-PVP patients underwent SDD, compared to a minority of TURP and HoLEP patients. SDD utilization increased, remained stable, and decreased over time for HoLEP, TURP, and GL-PVP, respectively. For 46,898 included cases (31,872 TURP, 2,901 HoLEP, 12,125 GL-PVP), rates of reoperation, CD I/II, or CD IV complications were comparable before and after matching. Compared to SLD, 30-day unplanned readmission rates for matched SDD patients were lower following TURP (3.48% vs 4.25%, P = .013) and HoLEP (1.93% vs 4.43%, P = .003). On multivariate regression, SLD correlated with unplanned readmission after TURP and HoLEP for both unmatched and matched cohorts.CONCLUSION:
For appropriately selected patients, SDD after TURP, HoLEP, and GL-PVP did not confer increased risk of 30-day complications, suggesting patient selection for SDD is being done with appropriate safety nationally.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Prostatic Hyperplasia
/
Transurethral Resection of Prostate
/
Laser Therapy
/
Lasers, Solid-State
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
/
Male
Language:
En
Journal:
Urology
Year:
2022
Document type:
Article