Aine Cryts is a freelancer based in Boston. She is a frequent contributor to Managed Healthcare Executive on topics such as diabetes, oncology, hospital admissions and readmissions, senior patients, and health policy.
Although monopolar transurethral resection of the prostate remains the standard of care for bladder outlet obstruction secondary to BPH, its utilization has decreased in recent years, according to a recent study.
Boston-Although monopolar transurethral resection of the prostate (TURP) remains the standard of care for bladder outlet obstruction secondary to BPH, its utilization has decreased in recent years, according to a recent study.
TURP is the standard of care for BPH in prostates under 80 mg, according to guidelines from the AUA and other international groups, but new approaches such as GreenLight Laser photoselective vaporization of the prostate (PVP), holmium laser ablation of the prostate (HoLAP), and holmium laser enucleation of the prostate (HoLEP) are increasingly being performed in the treatment of BPH.
Until recently, few studies have evaluated the perioperative outcomes of these procedures in the inpatient setting, said Christian P. Meyer, MD, a urologist at the University Medical Center Hamburg-Eppendorf in Hamburg, Germany, in his presentation at the 2017 AUA annual meeting in Boston.
For their research, Dr. Meyer and colleagues accessed the Premier Healthcare Database, an all-inpatient database representative of 20% of all U.S. hospital admissions, and looked at a cohort of approximately 140,000 patients who underwent monopolar TURP, bipolar TURP, or GreenLight Laser PVP for BPH. The timeline was from 2003 to 2013, and the research covered almost 450 hospitals across the United States. A range of inpatient settings, such as community hospitals and academic centers, was included in the study.
The research entailed searching the charge description master file to identify specific supply codes unique to each endoscopic procedure in order to identify them appropriately. Under evaluation were 90-day postoperative complications, operating room time, hospital length of stay, and indirect hospital costs. Also factored into the analyses were patient, hospital, and surgeon characteristics, Dr. Meyer said.
In terms of 90-day direct hospital costs, Dr. Meyer said that when bipolar and monopolar TURP were compared, bipolar TURP cost almost $1,000 more. The GreenLight Laser PVP cost almost $1,500 more than monopolar TURP.
Dr. Meyer observed that while monopolar TURP continues to be the standard of care for the treatment of BPH, he and colleagues observed a decreasing trend for the use of monopolar TURP, from 100% in 2003 to 78% in 2013. Further, the data showed an increasing trend for the use of procedures other than TURP to almost 11% in 2013.
When comparing bipolar and monopolar TURP, there was almost no difference in terms of operating room time, Dr. Meyer said. There was no difference in length of stay or 90-day complication rates, with borderline significance for urinary urgency favoring bipolar TURP. When compared with monopolar TURP, GreenLight Laser PVP procedures typically lasted 12 minutes longer than the full cohort, which is significant, he added. Still, the length of stay for the GreenLight Laser PVP patients was significantly shorter.
Because of the aging U.S. population and its high comorbidity profile, Dr. Meyer said focusing on procedures performed in an inpatient setting was appropriate, since these procedures will likely be performed in inpatient settings in the future.
He reported that the use of monopolar TURP has decreased significantly since the start of the study in 2003, but it’s still the standard of care for better surgical outcomes in the inpatient setting.
GreenLight Laser PVP was also associated with fewer cases of dilutional hyponatremia and prostatic complications such as structural fistula infarction and prostatic adhesions, added Dr. Meyer.
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