Introduction: Bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) represent one of the most common medical problems in adult men. Transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for BPH with excellent outcomes . Referencing publicly accessible Medicare data, the cost of an outpatient TURP is approximately $1667 compared to $4367 when done as an inpatient procedure. Prior research demonstrates a return to urgent care (UC)/ emergency department (ED) rate and readmission rate after TURP of 21.4% and 7.4%, respectively. Risk factors include age >75 years [OR 1.61, p < 0.001], urgent surgical status [OR 1.34, p = 0.0095], and Charlson Comorbidity Index > 1 [OR 5.31, p = 0.001] [2,3]. The primary objective of this study is determining the efficacy of same-day home recovery (SHR) TURP.
Methods: This study was a retrospective chart review of all TURPs done in integrated health care delivery system between June 2019 and August 2021. Patient variables including age, comorbidities, and perioperative factors were included for analysis. Appropriate statistical analyses were completed for categorical and continuous variables.
Results: 2559 TURPs were performed across seven medical centers in Southern California. Of these, 2138 were SHR versus 421 were admitted inpatient (length of stay (LOS) > 24 hours). The average age in both cohorts was 72 years old (31 - 101 years). The average LOS for inpatients was 28.8 hours (24.1 - 39.9 hours). Indication for TURP and anticoagulation status were not significantly different between the two groups. SHR patients returned to UC/ED within 30 days of their surgical date at a lower rate than those who were admitted inpatient, 12% versus 17%, respectively [OR 0.68, p = 0.00886]. Patients who were on anticoagulation returned at a higher rate than those who were not, 29% vs 11% [OR 3.38, p < 0.00001]. Inpatient admission of patients on anticoagulation did not reduce the rate of return to UC/ED when compared to SHR, 92.6% vs 13.7% [OR 78.62, p < 0.00001]. The most common reasons for return to UC/ED were catheter problems (25%), hematuria (12%), and LUTS (11%). The readmission rate was 0.2%.
Conclusions: Appropriately selected patients can be safely discharged home the same day after TURP. Admission to inpatient status and use of anticoagulation were found to be associated with statistically significant higher return to UC/ED rates.