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Holmium laser enucleation of the prostate (HoLEP) is one of the minimally invasive procedures that is used for patients with benign prostate hyperplasia. The procedure usually requires patients to stay in the hospital 2 nights or longer. The present study evaluated the safety and feasibility of HoLEP with discharge of the patients on Day 1 after su...
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After the devastating second wave of COVID-19, with the rapid increase in the number of new cases in many states of India marking the beginning of a probable third wave of COVID-19, our best bet is taking a jab to protect against COVID-19. Currently, licensed vaccines are found to be reasonably safe and effective. The second wave of COVID-19 was de...
Citations
... 15,16 Same-day HoLEP in particular has been shown to have significantly lower hospital-related costs in China. 17 In a study by Salonia et al. 18 investigating average hospitalization costs for open prostatectomy compared to HoLEP in Italy in 2004, costs for HoLEP were found to be 9.6% lower comparatively. This in This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. ...
Introduction:
Holmium laser enucleation of the prostate (HoLEP) has evidenced-based advantages in treating benign prostatic hypertrophy (BPH) relative to other interventions. Unfortunately, adoption of HoLEP has remained relatively low in Medicare and National Surgical Quality Improvement Program (NSQIP) populations. HoLEP's role as an inpatient surgical intervention is changing as advancements in the technique and systems have demonstrated the feasibility of same-day discharge. Thus, our objective was to evaluate national HoLEP trends in ambulatory surgery settings from 2016-2019.
Methods:
The Nationwide Ambulatory Surgery Sample (NASS) is the largest national all-payer database of ambulatory surgical encounters, managed by the Agency for Healthcare Research and Quality. A cross-sectional, retrospective analysis of the 2016 and 2019 NASS was performed. Rates of BPH surgeries were calculated and stratified by age, census region, and primary payer to compare across time-points for trends. Chi-squared and two-sample t-tests were completed for categorical and continuous variables, respectively.
Results:
The total number of ambulatory BPH surgeries fell 20% between 2016 (n=124,538) and 2019 (n=100,593). In 2016, HoLEP lagged behind photo-selective vaporization of the prostate (PVP) and Transurethral Resection of Prostate (TURP) with 4.7% of surgeries, but rose to the second most-common procedure in 2019 with 8.3% of total surgeries. TURP was the most common intervention (62.6% in 2016, 90.7% in 2019). Simple prostatectomy was the most expensive intervention. By US census region, more HoLEPs were done in the South (43.1% in 2016, 37.5% in 2019) and Midwest (26.8% in 2016, 31.7% in 2019).
Conclusion:
Overall, HoLEP uptake is increasing. HoLEP has replaced greenlight PVP as the second-most frequently used intervention. The rate of ambulatory HoLEPs has nearly doubled despite a general decrease in the number of surgeries.
... Performing LEP, PCNL, RARP surgeries as same-day procedures has the potential to greatly reduce resource usage and surgical wait times, not to mention decreasing overall costs 24,[26][27][28] . For example, during 2020-2021, the Canadian Institute for Health Information (CIHI) reported that 15 392 prostatectomies occurred making it the sixth most frequent inpatient surgery for patients 65 years and older in Canada; the average hospital stay was 3.1 days 29 . ...
Introduction:
In line with Canadian provincial directives due to the COVID-19 pandemic, certain elective urological surgical cases that are normally performed as inpatient procedures, were performed as same-day discharge procedures to reduce hospitalization and the usage of scarce healthcare resources. Since the pandemic, we began performing laser enucleation of the prostate (LEP), robotic-assisted radical prostatectomy (RARP), and percutaneous nephrolithotomy (PCNL) as outpatient surgeries. This was supported by recent evidence demonstrating the safety and feasibility of performing these minimally invasive surgeries as same-day procedures. As such, we sought to retrospectively evaluate the clinical outcomes and safety during the COVID-19 era at our institution for same-day discharge LEP, RARP, and PCNL procedures.
Methods:
All patients operated for LEP, RARP, or PCNL between May 2020 and March 2022 at two academic institutions were included. Surgeries were classified as planned same-day discharge or inpatient surgery. Same-day discharge patients were compared to inpatients for each procedure type. This comparison assessed the occurrence of same-day failure, postoperative complications, and re-admission rates at 30 days. This study was approved by the scientific ethics committee of the Centre de Recherche de l'Université de Montréal (CRCHUM).
Results:
A total of 413 subjects were included in this study. Among LEP patients (n=169), 104 (62%) were identified as same-day procedures and 65 (38%) were inpatient. Among RARP patients (n=194), 46 (24%) were identified as same-day procedures and 148 (76%) inpatient. Among PCNL patients (n=50), 38 (76%) were identified as same-day procedures and 12 (24%) were inpatient. Of the patients who underwent planned same-day LEP, RARP, and PCNL, 77.9%, 73.9%, and 71.1% were successfully discharged home, respectively. Patients who underwent LEP as inpatient had a higher incidence of overall postoperative complications compared to same-day LEP (23.1% vs. 8.7%, p=0.017). The rates of 30-day emergency department (ED) visits and hospital re-admission were similar between inpatient and same-day LEP (9.2% vs. 3.8%, p=0.27; and 4.6% vs. 1.0%, p=0.32, respectively). Inpatient RARP, however, was associated with more 30-day ED visits compared to same-day procedures (17.4% vs. 4.1%, p<0.01). No statistically significant differences were found for postoperative complications (15.2% vs. 6.1%, p=0.097) and re-admission rates (1.4% vs. 4.3%, p=0.51). There were no significant differences on overall postoperative complications, 30-day ED visits, and readmission rates in inpatient vs. same-day PCNL.
Conclusions:
Our results suggest that same-day discharge for LEP, RARP, and PCNL is safe and feasible in select patients with an acceptable complication rate. These results should be validated in a larger, prospective clinical trial comparing same-day and inpatient procedures.
... The high prevalence of LUTS associated with BPO and the aging population are contributing to the increase in medical burden due to surgical treatment indication for LUTS/ BPO [21,22,25]. This increases the appeal to adopt faster protocols in the treatment of this condition. ...
... Despite the emphasis given to the clinical and economic burden of LUTS/BPO and its treatment, only one study compared the costs related to short discharge. Sun et al. reported both a statistically significant difference in the costs between the two groups and a reduction in the waiting lists before endoscopic enucleation favoring SDD surgery [25]. Although cost reduction is primary motivation in this setting, a clear improvement has been proven in other procedures performed with an SDD protocol with a reduction up to 2000$/procedure [28]. ...
Purpose
To systematically review studies focused on the feasibility and outcomes of outpatient endoscopic enucleation of the prostate for benign prostatic obstruction.
Methods
A literature search was conducted through December 2022 using PubMed/Medline, Web of Science, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Risk of bias assessment was performed according to the Newcastle–Ottawa Scale for case control studies.
Results
Of 773 studies, ten were included in the systematic review (n = 1942 patients) and four in the meta-analysis (n = 1228 patients). The pooled incidence of successful same-day discharge was 84% (95% CI 0.72–0.91). Unplanned readmission was recorded in 3% (95% CI 0.02–0.06) of ambulatory cases. In the reported criteria-selected patients submitted to SDD surgery, the forest plot suggested a lower rate of postoperative readmission (OR 0.56, 95% CI 0.34–0.91, p = 0.02) and complications (OR 0.69, 95% CI 0.48–1, p < 0.05) rates compared to standard protocols.
Conclusion
We provide the first systematic review and meta-analysis on SDD for endoscopic prostate enucleation. Despite the lack of randomized controlled trials, we confirm the feasibility and safety of the protocol with no increase in complications or readmission rate in well-selected patients.
... These include technological advances, such as bipolar resection and laser enucleation for secure hemostasis [7] and minimized incidence of TUR syndrome, [8] as well as successful day case prostate surgery for cost savings and shortened hospital stay [9,10]. It is a common practice to discharge patients after 2 to 7 days after BPH surgery, the median length of stay for TURP continues to be two days, despite the introduction of bipolar systems [11,12,13] .The provision of day-case surgery would allow for greater patient flow by lowering the demand for hospital beds and improve clinical care through increased efficiency. Centers that offer day case bipolar or laser surgery for the treatment of BPH are gradually increasing in number especially in developed countries. ...
Transurethral endoscopic procedures using bi-
polar current, or laser energy are nowadays widely accepted and
have replaced the traditional old techniques in the treatment of
lower urinary tract symptoms due to benign prostatic hyperplasia.
TURP has been the gold standard surgical treatment for BPH for
a long time. Nonetheless, efforts are still being made to improve
the clinical results after TURP. These include technological ad-
vances, such as bipolar resection and laser enucleation for secure
hemostasis and minimized incidence of TUR syndrome, as well as
successful day case prostate surgery for cost savings and shortened
hospital stay.
1.2. Evidence Acquisitionː A systematic review was performed
from January 2011 through January 2021. Search engines used in-
cluded PubMed/ Medline, Scopus and Google scholar data bases.
Search query was: "Prostatic Hyperplasia/surgery"[Mesh] AND "
same day" OR "bipolar resection" OR "laser enucleation". Study
selection followed the PRISMA statement.
1.3. Evidence Synthesisː 9 studies from PubMed, 5 studies from
Google scholar and 01 study from Scopus data bases were final-
ly relevant for inclusion in this systematic review with a total of
4745 patients. Bipolar TURP and laser enucleation of the prostate
has demonstrated good results with high same day discharge rates
including the numerous benefits.
1.4. Conclusion: In conclusion, same day discharge after transure-
thral bipolar resection or laser enucleation showed to be safe, ef-
fective, with low complication rates, shorter hospital stay, shorter
catheterization time, overall cost saving, high patient satisfaction
and practicably successful even with large size prostate glands if
done according to the specific guidelines.
... It was similar to the cost reported in another study in China. 20 Due to our relatively conservative postoperative management, the postoperative hospitalization time in our study was longer than that reported in previous studies. 21,22 We used to keep the 23 Moreover, the enhanced recovery after surgery procedure was applied to some patients in recent years. ...
The present study aimed to determine whether the number of patients with symptomatic benign prostatic hyperplasia (BPH) who preferred surgery decreased during the past 11 years at our center (West China Hospital, Chengdu, China), and whether this change affected the timing of surgery and the physical condition of surgical patients. This retrospective study included 57 557 patients with BPH treated from January 2008 to December 2018. Of these, 5427 patients were treated surgically. Surgical patients were divided into two groups based on the time of treatment (groups 8–13 and groups 13–18). The collected data comprised the percentage of all patients with BPH who underwent surgery, baseline characteristics of surgical patients, rehabilitation time, adverse events, and hospitalization costs. The surgery rates in groups 8–13 and groups 13–18 were 10.5% and 8.5% (P < 0.001), respectively. The two groups did not clinically differ regarding patient age and prostate volume. The rates of acute urinary retention and renal failure decreased from 15.0% to 10.6% (P < 0.001) and from 5.2% to 3.1% (P < 0.001), respectively. In groups 8–13 and groups 13–18, the mean catheterization times were 4.0 ± 1.7 days and 3.3 ± 1.6 days (P < 0.001), respectively, and the mean postoperative hospitalization times were 5.1 ± 2.4 days and 4.2 ± 1.8 days (P < 0.001), respectively. The incidences of unplanned second surgery and death reduced during the study period. The surgery rate decreased over time, which suggests that medication was chosen over surgery. However, the percentage of late complications of BPH also decreased over time, which indicates that the timing of surgery was not delayed.
Background
Operations performed outpatient offer several benefits. The prevalence of outpatient operations is growing. Consequently, the proportion of patients with multiple comorbidities undergoing outpatient surgery is increasing. We compared 30-day mortality and overall morbidity between outpatient and inpatient elective operations.Methods
Using the 2005–2018 ACS-NSQIP database, we evaluated trends in percent of hospital outpatient operations performed over time, and the percent of operations done outpatient versus inpatient by CPT code. Patient characteristics were compared for outpatient versus inpatient operations. We compared unadjusted and risk-adjusted 30-day mortality and morbidity for inpatient and outpatient operations.ResultsA total of 6,494,298 patients were included. The proportion of outpatient operations increased over time, from 37.8% in 2005 to 48.2% in 2018. We analyzed the 50 most frequent operations performed outpatient versus inpatient 25–75% of the time (n = 1,743,097). Patients having outpatient operations were younger (51.6 vs 54.6 years), female (70.3% vs 67.3%), had fewer comorbidities, and lower ASA class (I–II, 69.3% vs. 59.9%). On both unadjusted and risk-adjusted analysis, 30-day mortality and overall morbidity were less likely in outpatient versus inpatient operations.Conclusion
In this large multi-specialty analysis, we found that patients undergoing outpatient surgery had lower risk of 30-day morbidity and mortality than those undergoing the same inpatient operation. Patients having outpatient surgery were generally healthier, suggesting careful patient selection occurred even with increasing outpatient operation frequency. Patients and providers can feel reassured that outpatient operations are a safe, reasonable option for selected patients.
Young Black men who have sex with men (MSM) living with HIV evidence the lowest rates of linkage to care and viral suppression of all US MSM. Kentucky, identified by the US Department of Health and Human Services as a “hot spot” state with elevated HIV incidence compared to the rest of the country, exhibits similar racialized outcomes. Structural, interpersonal, and individual drivers of engagement along the HIV care continuum among people living with HIV have been identified, primarily through quantitative designs. However, the mechanisms by which these factors shape HIV care engagement, and the ways they may combine or reinforce each other, as well as from the lived experience of young Black MSM living with HIV, have been studied to a lesser extent. In this study, a purposive sample of n = 29 HIV-positive young Black MSM (age M = 25 years old; 38% retained in care) residing in Kentucky participated in in-depth interviews. Factors that were most influential on engagement varied along the continuum, with health insurance status and knowledge of HIV being relatively more influential to diagnosis, and housing stability, psychological processes, and interpersonal relationships being more influential on retention. For some participants, barriers to care at multiple levels had a mutually influencing and intensifying impact on care engagement. Additional efforts to center the voices of young Black MSM living with HIV will help illuminate acceptable and sustainable interventions for increasing their care engagement and narrowing persistent racial disparities in HIV morbidity and mortality.
