Evaluating Factors That Influence Health Care Resource Utilization in Transurethral Resection of Prostate.

Abstract

Introduction: Transurethral resection of prostate (TURP) remains the gold standard for the treatment of benign prostatic hyperplasia, but it is associated with complications. The association of health care resource utilization (HRU) and TURP has been poorly studied. We seek to evaluate HRU in patients undergoing TURP and identify factors contributing to outcomes. Methods: The National Surgical Quality Improvement Program (NSQIP) database was reviewed from 2012 to 2018 for TURP by Current Procedural Terminology code. All data will be deidentified with IRB exemption. HRU was defined as discharge to continued care, unplanned readmission within 30 days, or prolonged length of stay (LOS) (>75th percentile). We included preoperative variables, including age, body mass index, diabetes, and ASA class (a classification system to assess for fitness of patients perior to surgery). Operative duration (OD) was broken into deciles by minutes. Preoperative characteristics and outcomes were compared against OD. Predictors of HRU were found using a stepwise multivariate logistic regression. Results: Overall, 38,749 patients were included. The following variables were significantly associated with OD (values are three shortest and three longest deciles, respectively): any HRU (35.9%, 32.4%, 31.4% and 32.4%, 33.7%, 37.6%) and prolonged LOS (31.3%, 27.6%, 26.5% and 28.0%, 30.4%, 34.1%). Findings in the first decile seemed to be an outlier, as shown in Figure 1. Complications associated with OD are shown in Figure 2. On multivariable analysis, patients with OD >58 minutes were more likely to have increased HRU; odds ratio 1.22, 1.33, 1.54, and 1.78 for deciles 58-66, 67-78, 78-99, and >100, respectively; p80, chronic obstructive pulmonary disease, dyspnea, hypertension, diabetes, not functionally independent, ASA class III and IV-V, and dirty/infected wound class, p < 0.005. [Figure: see text] [Figure: see text] Conclusions: OD is an independent predictor of HRU in patients undergoing TURP and is more modifiable than other preoperative variables associated with increased HRU. Patients in the longest decile were more likely to have complications and increased HRU. Further study is needed to evaluate causation.