Comparison of Cost and Perioperative Outcomes Among Patients Undergoing Simple Prostatectomy and Laser Enucleation of the Prostate

Abstract

Introduction Simple prostatectomy (SP) and laser enucleation of the prostate (LEP) are treatments for symptomatic benign prostatic hyperplasia (BPH) in men with large glands (e.g. >80 grams). The decision between the two operations is often dependent on surgeon preference/experience and equipment availability. As the use of minimally invasive techniques, such as robotic assisted simple prostatectomy (RASP), has increased for the treatment of large gland BPH, studies comparing the outcomes and cost of these modalities in a contemporary cohort are lacking. Methods All-payer data from Healthcare Cost and Utilization Project (HCUP) State Databases from Florida (FL), New York (NY), California (CA), and Maryland (MD) from 2016 and 2018 were used to identify adults who underwent SP or LEP for BPH. Patient demographics, facility characteristics, revisit rates, and cost of the index hospitalization were examined. Multivariable logistic and gamma generalized linear regression models were utilized to compare predictors of the operation performed, 30-day revisits, and index hospitalization cost amongst the two operations. Results Of the 2,032 patients in the cohort, 1,067 (46.4%) underwent LEP and 965 (41.9%) underwent SP. On multivariable logistic regression analysis, SP patients were younger, had higher comorbidity scores, and were more likely to be uninsured compared with LEP patients. 30-day revisit rates amongst the operations were equivalent (OR 0.89, 95% CI 0.63-1.27, p=0.05). The mean adjusted cost of the index hospital stay for LEP was significantly greater than that of SP ($7,291.23 vs $6442.32, p=0.04). However, our sub-group analysis examining high-volume centers revealed no significant differences in cost ($6,183.93 vs $5352.97, p=0.1). Conclusions Across the four states examined, SP and LEP were performed with comparable volume and had similar rates of 30-day revisits. SP was less expensive than LEP overall; however, among high-volume facilities the cost of both operations were reduced, such that they were equivalent.