Effect of Surgeon and Facility Volume on Outcomes of Benign Prostatic Hyperplasia Surgery: Implications of Disparities in Access to Care at High-Volume Centers

Published:November 18, 2022DOI:



      To report the effect of surgeon and facility volume on outcomes of transurethral resection of the prostate (TURP) and laser treatment of benign prostatic hyperplasia (BPH). We also investigate disparities in access to care by identifying demographic predictors of receipt of treatment at high-volume facilities.


      We used New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) data. We included 18,041 (41.4%) and 25,577 (58.6%) adult patients that underwent TURP and laser procedures in the outpatient setting between January 2005 and December 2018, respectively. Average annual surgeon and facility volumes were broken down by tertile. The effect of volume on short-term outcomes (30-day and 90-day readmission) was examined using mixed-effect logistic regression models. Cox-proportional-hazard models were used to assess the association between volume and long-term stricture development and reoperation. Demographic predictors of treatment at high-volume facilities were assessed using multinomial logistic regression.


      High-volume facilities were more likely to offer laser procedures compared to low-volume facilities. Higher facility and surgeon volume were associated with lower odds of 30 and 90-day readmissions compared to low-volume facilities. There was no difference in reoperation and stricture development between surgeon volume groups. Medicaid insurance, Hispanic ethnicity, and Black race were inversely associated with treatment at high-volume facilities.


      Higher surgeon and facility volumes were associated with lower odds of readmission. Higher facility volume was associated with lower hazards of reoperation and developing strictures. Medicaid insurance and non-white race were associated with lower odds of treatment at high-volume facilities, highlighting racial and socioeconomic disparities in access to high-volume BPH surgery facilities.
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        • Birkmeyer JD
        • Stukel TA
        • Siewers AE
        • et al.
        Surgeon volume and operative mortality in the United States.
        N. Engl. J. Med. 2003; 349: 2117-2127
        • Begg CB
        • Cramer LD
        • Hoskins WJ
        • et al.
        Impact of hospital volume on operative mortality for major cancer surgery.
        JAMA. 1998; 280: 1747-1751
        • Morche J
        • Mathes T
        • Pieper D.
        Relationship between surgeon volume and outcomes: a systematic review of systematic reviews.
        Syst. Rev. Pharm. 2016; 5: 1-15
        • Leow JJ
        • Leong EK
        • Serrell EC
        • et al.
        Systematic review of the volume–outcome relationship for radical prostatectomy.
        Eur Urol Focus. 2018; 4: 775-789
        • Sun M
        • Bianchi M
        • Trinh Q-D
        • et al.
        Hospital volume is a determinant of postoperative complications, blood transfusion and length of stay after radical or partial nephrectomy.
        J. Urol. 2012; 187: 405-410
        • Morgan TM
        • Barocas DA
        • Keegan KA
        • et al.
        Volume outcomes of cystectomy—is it the surgeon or the setting?.
        J. Urol. 2012; 188: 2139-2144
        • Goossens-Laan CA
        • Gooiker GA
        • van Gijn W
        • et al.
        A systematic review and meta-analysis of the relationship between hospital/surgeon volume and outcome for radical cystectomy: an update for the ongoing debate.
        Eur. Urol. 2011; 59: 775-783
        • Trinh Q-D
        • Bjartell A
        • Freedland SJ
        • et al.
        A systematic review of the volume–outcome relationship for radical prostatectomy.
        Eur. Urol. 2013; 64: 786-798
        • Siemens DR
        • Visram K
        • Wei X
        • et al.
        Effect of centralization on complex surgical care: a population-based case study of radical cystectomy.
        Can Urol Assoc J. 2020; 14: 91
        • Reitblat C
        • Bain PA
        • Porter ME
        • et al.
        Value-based healthcare in urology: a collaborative review.
        Eur. Urol. 2021; 79: 571-585
        • Jallad S
        • Hounsome L
        • Verne J
        • et al.
        Where are we with improving outcome guidance? An update on pelvic urological services in the NHS.
        J Clin Urol. 2017; 10: 29-33
        • Sugihara T
        • Yasunaga H
        • Horiguchi H
        • et al.
        Impact of hospital volume and laser use on postoperative complications and in-hospital mortality in cases of benign prostate hyperplasia.
        J. Urol. 2011; 185: 2248-2253
        • Nimptsch U
        • Mansky T.
        Hospital volume and mortality for 25 types of inpatient treatment in German hospitals: observational study using complete national data from 2009 to 2014.
        BMJ Open. 2017; 7e016184
        • Tascı AI
        • Ilbey Y
        • Tugcu V
        • et al.
        Transurethral resection of the prostate with monopolar resectoscope: single-surgeon experience and long-term results of after 3589 procedures.
        Urology. 2011; 78: 1151-1155
        • Shigemura K
        • Yamamichi F
        • Kitagawa K
        • et al.
        Does surgeon experience affect operative time, adverse events and continence outcomes in holmium laser enucleation of the prostate? A review of more than 1,000 cases.
        J. Urol. 2017; 198: 663-670
        • Stoddard MD
        • Zheng X
        • Mao J
        • et al.
        Safety and efficacy of outpatient surgical procedures for the treatment of benign prostatic enlargement in New York State and California (2005-2016).
        J. Urol. 2021; 205: 848-854
        • Vonlanthen R
        • Lodge P
        • Barkun JS
        • et al.
        Toward a consensus on centralization in surgery.
        Ann. Surg. 2018; 268: 712-724
        • Nguyen D-D
        • Marchese M
        • Ozambela M
        • et al.
        Ambulatory-based bladder outlet procedures offer significant cost savings and comparable 30-day outcomes relative to inpatient procedures.
        J. Endourol. 2020; 34: 1248-1254
        • Nabi J
        • Tully KH
        • Cole AP
        • et al.
        Access denied: The relationship between patient insurance status and access to high-volume hospitals.
        Cancer. 2021; 127: 577-585
        • Trinh QD
        • Sun M
        • Sammon J
        • et al.
        Disparities in access to care at high-volume institutions for uro-oncologic procedures.
        Cancer. 2012; 118: 4421-4426