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John, Joseph B.; Gray, William K.; O'Flynn, Kieran; Briggs, Tim W.R.; McGrath, John S.
BJU international, January 2024, 2024-01-00, 20240101, Volume: 133, Issue: 1Journal Article
Objectives To describe the contemporary evolution of day‐case bladder outflow obstruction (BOO) surgery in England and to profile day‐case BOO surgery practices across England in terms of the types of operation performed and their safety profiles. Materials and Methods This was a retrospective observational analysis of Hospital Episode Statistics and UK Office for National Statistics data. All 111 043 recorded operations across 117 hospital trusts over 66 months, from 1 January 2017 to 30 June 2022, were obtained. Operations were identified as one of: transurethral resection of prostate (TURP); laser ablation or enucleation; vapour therapy; prostatic urethral lift (PUL); or bladder neck incision. Monthly day‐case rate trends were plotted across the study period. Descriptive data, day‐case rates and 30‐day hospital readmissions were analysed for each operation type. Multilevel regression modelling with mixed effects was performed to determine whether day‐case surgery was associated with higher 30‐day hospital readmissions. Results Day‐case patients were younger, with fewer comorbidities. Time series analysis showed a linear day‐case rate increase from 8.3% (January 2017) to 21.0% (June 2022). Day‐case rates improved for 92/117 trusts in 2021/2022 compared with 2017. Three of the six trusts with the highest day‐case rates performed predominantly day‐case TURP, and the other three laser surgery. Nationally, PUL and vapour surgery had the highest day‐case rates (80.9% and 38.1%). Most inpatient operations were TURP. Multilevel regression modelling found reduced odds of 30‐day readmission after day‐case BOO surgery (all operations pooled), no difference for day‐case vs inpatient TURP, and reduced odds following day‐case LASER operations. Conclusions The day‐case rates for BOO surgery have linearly increased. Minimally invasive surgical technologies are commonly performed as day cases, whereas high day‐case rates for TURP and for laser ablation operations are seen in a minority of hospitals. Day‐case pathways to treat BOO can be safely developed irrespective of operative modality.
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