235 Morbidity and mortality after benign prostatic hyperplasia surgery: Data from the national surgical quality improvement program

235

Morbidity and mortality after benign prostatic hyperplasia surgery: Data from the national surgical quality improvement program Eur Urol Suppl 2014;13;e235          

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Varda B. 1 , Sood A. 2 , Marianne S. 3 , Ghani K.R. 4 , Rai A. 1 , Pucheril D.2 , Chang S.L. 1 , Peabody J.O. 2 , Menon M. 2 , Olugbade Jr. K. 1 , Ruhotina N.5 , Sammon J.D. 2 , Sukumar S. 6 , Kibel A.S.1 , Zorn K.C. 7 , Trinh Q-D.1 1 Brigham

and Women’s Hospital, Dept. of Urologic Surgery, Boston, United States of America, 2 Henry Ford Health System, Dept. of

Urology, Detroit, United States of America, 3 University Medical Center Hamburg-Eppendorf, Dept. of Urology, Hamburg, Germany, 4 University

of Michigan, Dept. of Urology, Ann Arbor, United States of America, 5 Brigham and Women’s Hospital, Dept. of of Urologic

Surgery, Boston, United States of America, 6 University of Minnesota, Dept. of Urology, Minneapolis, United States of America, 7 University of Montreal Health Center, Dept. of Cancer Prognostics and Health Outcome, Montreal, Canada INTRODUCTION & OBJECTIVES: With the aging population, it is important to identify patients who may be at risk of developing complications from surgical intervention and who may better be served with conservative management of their lower urinary tract symptoms (LUTS) and/or urinary retention (UR). Thus, we sought to identify predictors of morbidity after surgical treatment of BPH using a large national contemporary cohort of patients. MATERIAL & METHODS: The current study relied on the National Surgery Quality Improvement Program (NSQIP) database. Morbidity and mortality of different surgical procedures for the treatment of BPH was examined using different covariates and post-operative outcomes. Surgical interventions included transurethral resection of the prostate (TURP), laser vaporization of the prostate (LVP) and laser enucleation of the prostate (LEP). Multivariable logistic regression models tested the association between preoperative covariates and the rate of blood transfusions, prolonged length of stay, overall complications, perioperative mortality and readmission rates. RESULTS: Overall, 4794 (65.2%), 2439 (33.1%) and 126 (1.7%) patients underwent TURP, LVP and LEP, respectively. No significant difference in overall complications or perioperative mortality between the three surgical groups was found. LVP was found to be associated with decreased blood transfusions, prolonged length of stay and reintervention rates. LEP was found to be associated with decreased prolonged length of stay. Multivariate analysis demonstrated that age at surgery, non Caucasian race and smokers were at an increased risk of morbidity and mortality. In contrast normal preoperative albumin and a higher preoperative hematocrit (>30%) were the only predictors of lower overall complications and perioperative mortality (Table 1).

CONCLUSIONS: We show that all three major surgical modalities for treatment of BPH are safe. Age, race and smoking status were independent predictors of adverse outcomes after BPH surgery. In patients with these attributes, an alternative, less morbid surgical approach should be identified or a more conservative treatment plan should be put in place. Finally, preoperative hematocrit and albumin levels represent reliable serum markers for prediction of adverse outcomes, suggesting that these markers should be evaluated before BPH surgery.