Patients with bladder outlet obstruction (BOO) who do not respond to pharmacotherapy treatment may undergo surgery. In favor of cost reduction and minimally invasive outlet procedures, patients may be treated in an ambulatory surgical center as opposed to the traditional inpatient setting. In the present study, researchers evaluated risk factors associated with 30-day revisits and costs in postoperative BOO patients. The findings of the study were presented at the 2019 American Urological Association Annual Meeting.
The study included all-payer data from the 2014 Healthcare Cost and Utilization Project (HCUP) State Databases from Florida and New York. Patients who underwent an index transurethral resection (TURP), laser/photovaporization (PVP), or thermotherapy (TUMT/TUNA) were eligible for inclusion. Researchers assessed patient demographics, regional data, 30-day revisit rates, and total charges—which were converted to costs—associated with revisit; they used multivariate logistic regression analysis adjusted for facility clustering to determine risk factors associated with 30-day revisit.
The final analysis included 15,094 BOO patients; 1,444 (9.6%) sustained a 30-day revisit. The median 30-day revisit cost was $4,263.43. Patients treated in the inpatient setting were more likely to require 30-day revisit compared to those who underwent ambulatory procedures (12% vs. 8.1%, P < 0.001). The following risk factors were associated with increased risk of 30-day revisit: older age (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.00-1.02, P = 0.002), higher Charlson Comorbidity Index score (CCI ≥ 2 vs. 0: OR 1.75, 95% CI 1.49-2.04, P < 0.001), payer status (private vs. Medicare: OR 0.77, 95% CI 0.62-0.95, P = 0.02), median household income (≥ $66,000 vs. < $40,000: OR 0.72, 95% CI 0.57-0.93, P = 0.004), and index care setting (ambulatory vs. inpatient: OR 0.48, 95% CI 0.40-0.57, P < 0.001).
The authors concluded that the risk of 30-day revisit was significant among BOO patients treated in the inpatient setting as well as those with Medicare. According to the researchers, “Our findings have important policy implications in the setting of recent value-based purchasing efforts, which seek to reduce variation in non-clinical sources of perioperative costs and outcomes.”
Friedlander D, Krimphove M, Cole A, et al. Effect of Index Surgical Care Setting on 30-day Revisit Rates and Associated Costs Following Outlet Procedure for Symptomatic Benign Prostatic Hyperplasia. Presented at the 2019 American Urological Association Annual Meeting.