A National, Comparative Analysis of Perioperative Outcomes of Open and Minimally Invasive Simple Prostatectomy

Abstract

Purpose: To compare perioperative outcomes of open (OSP) and minimally invasive (MISP) simple prostatectomy for benign prostatic hyperplasia (BPH) in a large national cohort using validated patient safety measures.

Patients and methods: We studied patients undergoing simple prostatectomy for BPH in the Nationwide Inpatient Sample (NIS) from 1998 to 2010 and used weighted sampling to estimate national trends. Patient safety indicators (PSI) and multivariable regression were used to generate adjusted odds ratios (ORadj) comparing OSP with MISP.

Results: We identified 34,418 and 193 patients undergoing OSP and MISP, respectively. Although the overall frequency of simple prostatectomy cases decreased from 3157 cases in 1998 to 2227 cases in 2010, the annual frequency increased each year from 2008 to 2010. We focused on 2008 to 2010 for the comparative outcome analyses. Among all OSP cases during this period (n=6027), the transfusion prevalence was 21%. MISP patients were more likely to have higher Charlson comorbidity scores (P=0.11) and less likely to undergo transfusion (P=0.13), but these differences did not attain significance. There were no significant differences in median length of stay (LOS) (P=0.19), hospital charges (P=0.15), or unadjusted in-hospital mortality (P=0.73). PSI frequency was low, and did not differ significantly between groups (ORadj 1.59, 95% confidence interval 0.26 to 9.53, P=0.61).

Conclusions: In this, the first national analysis of simple prostatectomy, use of both OSP and MISP rose substantially from 2008 to 2010. Although transfusion prevalence was lower and LOS shorter for MISP, these differences did not attain significance. Further comparative analyses are needed.