Transfusion rate high with prostatectomy for BPH

San Diego-Analyses of data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project are providing understanding on trends in utilization of simple prostatectomy for treatment of symptomatic BPH and addressing the gap in information about its outcomes.

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In the retrospective study, researchers analyzed data for the years 1998 to 2010 and showed the frequency of simple prostatectomy for BPH was low and decreased over the study period from 3,150 cases in 1998 to 2,230 cases in 2010. However, after reaching a low in 2008, the number of procedures performed annually steadily increased over the next 2 years.

Results from a comparative analysis focusing on data from 2008 to 2010 found that whether performed using an open technique or a minimally invasive approach, prostatectomy was associated with a relatively high rate of perioperative transfusion, but low rates of patient safety indicator (PSI) events. The perioperative transfusion data seemed to favor the minimally invasive procedure.

However, due in part to limited power, the study found no statistically significant differences between the two approaches for any perioperative outcomes, reported senior author J. Kellogg Parsons, MD, MHS, associate professor of urology at the University of California, San Diego.

NEXT: Study provides Level 3 evidence

Dr. Parsons“Simple prostatectomy has been recognized for a long time as an appropriate intervention for select men with symptomatic BPH. However, all published literature on this procedure describes small case series and represents Level 3 evidence,” Dr. Parsons said.

“This report provides the first national data on validated patient safety indicators for simple prostatectomy, and it addresses the dearth of Level 1 and Level 2 evidence comparing minimally invasive and open procedures.”

The study, presented at the 2014 AUA annual meeting in Orlando, FL, identified 34,611 patients who underwent simple prostatectomy between 1998 and 2010. Between 2008 and 2010, there were 6,027 cases of open simple prostatectomy (OSP) and 182 cases of minimally invasive simple prostatectomy (MISP). The comparative analysis did not use earlier data because very few MISP cases were performed prior to 2008.

There were no significant differences between the OSP and MISP groups with respect to mean age (~70 years) or distributions of race, Charlson comorbidity scores, insurance status, income zip code, or hospital type (urban vs. rural and teaching vs. non-teaching). However, about 95% of both procedures were done at urban centers, and the MISP procedures were predominantly done in teaching hospitals (~80%).

Shorter stay for minimally invasive procedure

Mean length of stay was 1 day shorter for the men who had MISP compared to OSP (3.7 vs. 4.7 days; p=.19), but the MISP group had higher mean hospital charges ($47,423 vs. $32,462; p=.15).

Dr. Parsons reported that the transfusion rate was twofold higher in men who had the open procedure compared with the MISP group, and that this protective effect approached statistical significance (21% vs. 10%; p=.13).

“The transfusion rate for the open group is consistent with that reported in published series. In the future, as more data are collected for the MISP group, we would expect to have the power to identify a statistically significant difference in transfusion rate compared to OP,” he said.

Dr. Parsons added that he and his colleagues at the University of California, San Diego have performed 25 cases of MISP without any patient needing a transfusion, an observation that corresponds to other single-institution series.

“We think the overall transfusion rate for the MISP group in the Nationwide Inpatient Sample sample is high,” he said. “It is important to keep in mind that this rate represents nationwide outcomes in a nationwide database. We lack granularity in the data that would allow us to investigate whether this relatively high transfusion rate represents a learning curve effect or is explained by any other factors.”

There were no in-hospital deaths among men who underwent MISP. The in-hospital mortality rate for OSP was 0.4%.

Discharge codes were used to identify data for the 16 PSI measures validated for surgery patients. The rate of any PSI in the OSP group was 0.4%, and the PSI occurring at the highest frequency was failure to rescue (8.7%). There were no statistically significant differences between groups in the rates for any PSI or for any 16 individual PSIs.

On multivariate analysis comparing the two procedures, there was no significant difference in the adjusted probability of any PSI. The multivariate analysis also showed that patient age, Charlson comorbidity index (≤2 vs. 3+), and type of institution (teaching vs. non-teaching) did not predict the probability of experiencing any PSI.

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