Same-Day Discharge after Holep Does Not Impact Rates of Unanticipated Healthcare Utilization

Abstract

PurposeSame-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) is increasingly performed for Benign Prostate Hyperplasia (BPH) with comparable postoperative outcomes as standard admission. However, rates of unanticipated healthcare utilization (UHU), which impact healthcare costs, remain unknown. This study examines whether SDD leads to increased UHU.MethodsA retrospective study of patients who underwent HoLEP at a single academic center between 2018-2023. Demographic, medical, and perioperative data were abstracted from the EHR. Patients with a prostate size <150g, ASA class [[EQUATION]] 2, and sufficient social support met SDD criteria. Primary outcomes were hospital readmissions or emergency department (ED) visits and UHU, defined as unplanned clinic visits, phone calls, and EHR messages within 30 days after the surgery. Student’s t-test, chi-square analysis, and multivariable logistic regression models were used for analysis.Results469 patients were included, of which 37% (173) had SDD and 63% (296) had standard admission. The SDD group was younger (70 vs 71, p=0.005), had smaller prostate sizes (86 ± 44.7 vs 114 ± 73.6, p= <0.001), and had lower rates of catheter dependency (43% vs 28%, p=0.001). On adjusted regression analysis, SDD did not predict ED visits, hospital readmissions, or unanticipated healthcare utilization (p>0.05). SDD was associated with reduced rates of clinic calls (OR: 0.53 CI: (0.31-0.94), p=0.03).ConclusionSDD after HoLEP was associated with decreased UHU, largely reflected by reduced rates of clinic calls. This suggests that SDD is a safe discharge strategy that can improve healthcare delivery while conserving valuable resources.

Note:
Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of Interests: The authors declare that they have no known financial or personal relationships that could have appeared to influence the work reported in this paper. All authors have reviewed and approved the final manuscript and affirm that there are no conflicts of interest to disclose.

Ethical Approval: This was an IRB approved (IRB #24-43006) study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee. Due to the retrospective nature of the study, informed consent was waived, and all patient data were de-identified for analysis to maintain privacy and confidentiality of patients.

Keywords: Prostatic Hyperplasia, Urologic Surgical Procedures, Male, Perioperative Care, Ambulatory Services, Health Services Research