Same Day Discharge is a Successful Approach for the Majority of Patients Undergoing Holmium Laser Enucleation of the Prostate.

Adult Holmium Humans Lasers, Solid-State / therapeutic use Male Patient Discharge Postoperative Complications / epidemiology Prostate / surgery Prostatic Hyperplasia / surgery Retrospective Studies Treatment Outcome
Anticoagulation Benign prostatic hyperplasia Holmium laser Holmium laser enucleation of the prostate Outcomes Prostate enucleation Same day surgery

Journal

European urology focus
ISSN: 2405-4569
Titre abrégé: Eur Urol Focus
Pays: Netherlands
ID NLM: 101665661

Informations de publication

Date de publication:
Jan 2022
Historique:
received: 11 09 2020
revised: 03 12 2020
accepted: 18 12 2020
pubmed: 9 1 2021
medline: 15 4 2022
entrez: 8 1 2021
Statut: ppublish

Résumé

Limited research has focused on success with hospital discharge on the same day of surgery after holmium laser enucleation of the prostate (HoLEP). To determine the success of same-day discharge in our HoLEP cohort and factors associated with this approach. A retrospective review of our prospectively maintained HoLEP database demonstrated that 473 adult males underwent HoLEP from July 2018 to December 2019 at a tertiary referral center and high-volume HoLEP hospital. Patients were divided into groups according to planned inpatient admission (PIA), successful same-day discharge (SDD), or unplanned admission (UA). The PIA, SDD, and UA groups were assessed for differences in preoperative demographic data, perioperative surgical data, and postoperative follow-up data. SDD and UA were then compared to determine if any specific factors predicted UA, including univariate and multivariate logistic regression analyses. Age (p = 0.0049), use of anticoagulation (p = 0.037), American Society of Anesthesiologists score of 3-4 (p = 0.0017), and enucleation time (p=0.0178) were significantly higher in the PIA group. Morcellation time (p = 0.0059) and the rate of bedside catheter irrigation (p = 0.04) were higher in the UA group. The SDD group had the highest rate of successful voiding trial (p = 0.0001). Among the three groups, there was no difference in the rate of postoperative complications (p = 0.141). In a comparison of the SDD and UA groups, morcellation time (p = 0.041), the rate of bedside clot evacuation (p = 0.004), and successful voiding trial (p = 0.003) all favored SDD. There was no difference in 90-d complications (p = 0.536). A limitation is the retrospective nature of this study. HoLEP can be successfully performed as day surgery without an increase in postoperative complications. HoLEP as day surgery is possible for any patient who does not require admission for medical comorbidities. Same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) is possible and is successful in 87.4% of patients. Patients with longer morcellation times and with post-procedure hematuria with clots are more likely to have an unplanned admission. Use of a 120-W modulated-pulse laser resulted in a higher rate of SDD success. The culture change to day surgery is time-intensive owing to education of the postsurgical care units and clinic staff, and in our experience took approximately 9 mo to seamlessly integrate SDD as our HoLEP standard of care.

Sections du résumé

BACKGROUND BACKGROUND
Limited research has focused on success with hospital discharge on the same day of surgery after holmium laser enucleation of the prostate (HoLEP).
OBJECTIVE OBJECTIVE
To determine the success of same-day discharge in our HoLEP cohort and factors associated with this approach.
DESIGN, SETTING, AND PARTICIPANTS METHODS
A retrospective review of our prospectively maintained HoLEP database demonstrated that 473 adult males underwent HoLEP from July 2018 to December 2019 at a tertiary referral center and high-volume HoLEP hospital. Patients were divided into groups according to planned inpatient admission (PIA), successful same-day discharge (SDD), or unplanned admission (UA).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS METHODS
The PIA, SDD, and UA groups were assessed for differences in preoperative demographic data, perioperative surgical data, and postoperative follow-up data. SDD and UA were then compared to determine if any specific factors predicted UA, including univariate and multivariate logistic regression analyses.
RESULTS AND LIMITATIONS CONCLUSIONS
Age (p = 0.0049), use of anticoagulation (p = 0.037), American Society of Anesthesiologists score of 3-4 (p = 0.0017), and enucleation time (p=0.0178) were significantly higher in the PIA group. Morcellation time (p = 0.0059) and the rate of bedside catheter irrigation (p = 0.04) were higher in the UA group. The SDD group had the highest rate of successful voiding trial (p = 0.0001). Among the three groups, there was no difference in the rate of postoperative complications (p = 0.141). In a comparison of the SDD and UA groups, morcellation time (p = 0.041), the rate of bedside clot evacuation (p = 0.004), and successful voiding trial (p = 0.003) all favored SDD. There was no difference in 90-d complications (p = 0.536). A limitation is the retrospective nature of this study.
CONCLUSIONS CONCLUSIONS
HoLEP can be successfully performed as day surgery without an increase in postoperative complications. HoLEP as day surgery is possible for any patient who does not require admission for medical comorbidities.
PATIENT SUMMARY RESULTS
Same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) is possible and is successful in 87.4% of patients. Patients with longer morcellation times and with post-procedure hematuria with clots are more likely to have an unplanned admission. Use of a 120-W modulated-pulse laser resulted in a higher rate of SDD success. The culture change to day surgery is time-intensive owing to education of the postsurgical care units and clinic staff, and in our experience took approximately 9 mo to seamlessly integrate SDD as our HoLEP standard of care.

Identifiants

DOI: 10.1016/j.euf.2020.12.018 PMID: 33414073
pubmed: 33414073
pii: S2405-4569(20)30320-5
doi: 10.1016/j.euf.2020.12.018
pii:
doi:

Substances chimiques

Holmium W1XX32SQN1

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

228-234

Informations de copyright

Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Auteurs

Deepak K Agarwal (DK)

Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.

Tim Large (T)

Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.

Yan Tong (Y)

Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.

Christa L Stoughton (CL)

Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.

Erica M Damler (EM)

Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.

Charles U Nottingham (CU)

Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.

Marcelino E Rivera (ME)

Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.

Amy E Krambeck (AE)

Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address: gecoots2@gmail.com.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Same Day Discharge is a Successful Approach...
questionsmedicales.fr › Produits chimiques inorganiques › Métaux › Terres rares › Lanthanides › Holmium › Same Day Discharge is a Successful Approach...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Same Day Discharge is a Successful Approach...
questionsmedicales.fr › Équipement et fournitures › Équipement et fournitures pour les applications des radiations › Lasers › Lasers à solide › Same Day Discharge is a Successful Approach...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Sortie du patient › Same Day Discharge is a Successful Approach...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Same Day Discharge is a Successful Approach...
questionsmedicales.fr › Tissus › Glandes exocrines › Prostate › Same Day Discharge is a Successful Approach...
questionsmedicales.fr › Maladies urogénitales › Maladies urogénitales de l'homme › Maladies de l'appareil génital mâle › Maladies de la prostate › Hyperplasie de la prostate › Same Day Discharge is a Successful Approach...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Same Day Discharge is a Successful Approach...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Same Day Discharge is a Successful Approach...