Abstract
Objective
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.
Methods
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.
Results
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.
Conclusion
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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Article info
Publication history
Published online: November 18, 2022
Accepted:
September 15,
2022
Received:
July 5,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
David-Dan Nguyen and David Bouhadana contributed equally.
Financial Disclosure: BC is a consultant for Boston Scientific, Olympus, Medeon Bio, Urovant, and Ferring. NB and KCZ are consultants and investigators for Boston Scientific, Olympus, and PROCEPT BioRobotics. DSE is a consultant for Boston Scientific, Olympus, Prodeon, PROCEPT BioRobotics, Urotronic, and Zenflow. All other authors report no relevant conflicts of interest.
Identification
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© 2022 Elsevier Inc. All rights reserved.
