Introduction: Surgery for benign prostatic hyperplasia (BPH) is commonly performed in an outpatient setting. Although transurethral resection of the prostate (TURP) has been considered gold standard in treatment for BPH, new literature shows better outcomes with holmium laser enucleation of the prostate (HoLEP). Using the National Improvement Quality Improvement Program (NSQIP), we evaluated the factors related to extended hospital stay (beyond 24 hours) in patients undergoing HoLEP for BPH.
Methods: Using NSQIP data from 2011-2019, we identified adult men who underwent HoLEP for the treatment of BPH (CPT code: 52649). We dichotomized the study population based on early ( <24 hours) [ED] versus late (=24 hours) discharge [LD]. Preoperative profiles and 30-day clinical outcomes were then compared between groups, using Student’s t-test (continuous variables) and Pearson’s Chi-squared test (categorical variables). We used multivariate logistic regression analysis to determine factors associated with ED or LD; odds ratios (OR) with 95% confidence intervals (CI) were reported. All statistical analyses were performed using SPSS (v28.0) and R (v4.1.0), with significance set at p < 0.05.
Results: A total of 4,418 cases met inclusion criteria with 1,247 patients having ED and 3,171 patients having LD. The patient cohort tended to be elderly (69 years old average) and Caucasian (81.0%). Major patient comorbidities included obesity (BMI of 28), chronic hypertension (57.5%), and diabetes (19.1%). Patients with LD tended to be non-Caucasian (12.2% vs 6.6%) and to experience longer operation times (101 minutes vs 71 minutes) with a high level of significance (p < 0.001). Patients with LD had a higher risk of a major complication (2.9% vs 1.1%) with significant differences (p <0.05).
Conclusions: Despite HoLEP commonly being performed in an outpatient setting, only 1 in 4 patients in this NSQIP cohort had hospital stays less than 24 hours. Longer operation times was a major predictor of having LD (p < 0.001). Although patients with LD had similar rates of reoperation and readmissions compared to ED, patients with an LD have higher risks of experiencing a major complication.
.jpg)
.jpg)