Trends in day-case bladder outflow obstruction surgery: a study using Hospital Episode Statistics

Area of Science:

• Urology
• Surgical Innovation
• Health Services Research

Background:

• Bladder outflow obstruction (BOO) is a common condition requiring surgical intervention.
• Day-case surgery offers potential benefits in terms of cost-effectiveness and patient recovery.
• The adoption and safety of day-case BOO surgery practices in England require contemporary evaluation.

Purpose of the Study:

• To describe the evolution of day-case surgery for bladder outflow obstruction (BOO) in England.
• To profile current day-case BOO surgery practices, including operation types and safety outcomes.
• To analyze trends and variations in day-case BOO surgery rates across English hospitals.

Main Methods:

• Retrospective analysis of Hospital Episode Statistics and UK Office for National Statistics data (January 2017 - June 2022).
• Inclusion of 111,043 operations across 117 hospital trusts, categorized by procedure type (TURP, laser, vapour, PUL, bladder neck incision).
• Multilevel regression modeling to assess the association between day-case surgery and 30-day hospital readmissions.

Main Results:

• A linear increase in day-case BOO surgery rates from 8.3% to 21.0% was observed between January 2017 and June 2022.
• Prostatic urethral lift (PUL) and vapour therapy demonstrated the highest day-case rates (80.9% and 38.1%, respectively).
• Day-case surgery was associated with reduced odds of 30-day readmission overall, with no difference for TURP and reduced odds for LASER operations.

Conclusions:

• Day-case rates for bladder outflow obstruction surgery have significantly increased in England.
• Minimally invasive procedures are frequently performed as day cases, while high day-case rates for TURP and laser surgery are concentrated in a few hospitals.
• Safe and effective day-case pathways for BOO treatment can be established across various surgical modalities.