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. 2023 Mar;11(1):20-26.
doi: 10.1016/j.prnil.2022.07.003. Epub 2022 Aug 5.

Predictors of readmission and impact of same-day discharge in holmium laser enucleation of the prostate

Carlos Riveros  1 , Elizabeth Di Valerio  2 , Michael Bacchus  2 , Victor Chalfant  1 , Navid Leelani  1 , Devon Thomas  1 , Seyed B Jazayeri  1 , Joseph Costa  1
Affiliations

Predictors of readmission and impact of same-day discharge in holmium laser enucleation of the prostate

Carlos Riveros et al. Prostate Int. 2023 Mar.

Abstract

Background: Holmium enucleation of the prostate (HoLEP) is becoming the gold standard for the treatment of benign prostatic hyperplasia (BPH). Our objective was to identify predictors of 30-day readmission and the impact of same-day discharge after HoLEP.

Methods: Using NSQIP data from 2011 to 2019, we identified men who underwent HoLEP for the treatment of BPH. We compared patients based on time of discharge and readmission status. We used multivariable logistic regression analysis (MLRA) to identify independent factors associated with 30-day readmission.

Results: A total of 3,489 patients met inclusion criteria with 833 (23.88%) being discharged within 24 hours and 2,656 (76.12%) discharged after 24 hours. There were 158 (4.53%) 30-day readmissions, mostly due to hematuria and urinary tract infection. Patients being readmitted were older (72 vs. 70 years old, P = 0.001), were more likely to have preoperative anemia (36.7% vs. 23.1%; P < 0.001), chronic kidney disease (29.7% vs. 19.7%; P < 0.001), bleeding disorder (10.8% vs. 2.8%; P < 0.001), higher American Society of Anesthesiologists (ASA) scores (≥3: 70.3% vs. 46.7%; P < 0.001) and a higher frailty burden (5-item modified frailty index [5i-mFI] ≥ 2: 36.1% vs. 19.1%; P < 0.001) compared to their counterparts. Factors independently associated with 30-day readmission were bleeding disorder (OR 2.89; 95% CI 1.63-5.11; P < 0.001), 5i-mFI ≥ 2 (OR 1.67; 95% CI 1.03-2.71; P = 0.038) and an ASA score ≥3 (OR 1.80; 95% CI 1.21-2.70; P = 0.004); however, same-day discharge was not found to be a significant predictor of 30-day readmissions.

Conclusion: The overall readmission rate after HoLEP is low. Patients discharged within 24 hours have similar rates of readmission compared to patients discharged after 24 hours. We found bleeding disorder, frailty burden, and ASA score to be independent predictors of 30-day readmission.

Keywords: Benign prostatic hyperplasia; Holmium laser enucleation of the prostate; Outcomes; Readmissions.

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Conflict of interest statement

The authors have no material or financial conflicts of interest to disclose.

Figures

Figure 1
Fig. 1
Flowchart of patient inclusion and exclusion using NSQIP, 2011 to 2019
Figure 2
Fig. 2
Percent of HoLEP cases with same-day discharge and 30-day readmission between 2011–2019
See this image and copyright information in PMC

Comment in

  • Benign Prostatic Hyperplasia.
    Kaplan SA. Kaplan SA. J Urol. 2023 Oct;210(4):704-706. doi: 10.1097/JU.0000000000003622. Epub 2023 Jul 25. J Urol. 2023. PMID: 37490596 No abstract available.

References

    1. Egan K.B. The epidemiology of benign prostatic hyperplasia associated with lower urinary tract symptoms: prevalence and incident rates. Urol Clin N Am. 2016;43 - PubMed
    1. Roehrborn C.G. 2005. ILC IN THE TREATMENT OF BPH Benign Prostatic Hyperplasia: An Overview. - PMC - PubMed
    1. Lokeshwar S.D., Harper B.T., Webb E., Jordan A., Dykes T.A., Neal D.E., et al. Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Transl Androl Urol. 2019;8 - PMC - PubMed
    1. Sriprasad S., Feneley M.R., Thompson P.M. History of prostate cancer treatment. Surg Oncol. 2009;18 - PubMed
    1. Michalak J., Tzou D., Funk J. HoLEP: the gold standard for the surgical management of BPH in the 21(st) Century. Am J Clin Exp Urol. 2015;3(1) - PMC - PubMed