title: Impact of hospital volume and laser use on postoperative complications and in-hospital mortality in cases of benign prostate hyperplasia.
abstract: OBJECTIVE
  We analyzed the impact of hospital volume and laser use on postoperative complications and in-hospital mortality in transurethral prostatic surgery.
  
  
  METHODS
  We evaluated data from 18,578 patients in 686 hospitals who underwent transurethral prostatic surgery between July and December, 2006 to 2008, using the Diagnosis Procedure Combination database in Japan. Cases were divided into low (14 or less per year), medium (14 to 29 per year) or high (30 or more per year) hospital volume groups. Logistic regression analyses were conducted to determine the concurrent effects of hospital volume, laser use and other factors on postoperative complications, transfusion and in-hospital mortality. Laser devices included neodymium:yttrium aluminum garnet and holmium:yttrium aluminum garnet lasers.
  
  
  RESULTS
  The overall in-hospital mortality was 0.05% (10 of 18,578 patients) and was not significantly different among groups. The transfusion rates of the low, medium and high volume groups were 8.3%, 7.0% and 5.5%, respectively (low vs high volume adjusted odds ratio 1.55, p <0.01), and postoperative complication rates were 3.7%, 3.2% and 2.6% (low vs high volume OR 1.425, p = 0.016), respectively. An absence of laser use was also a significant risk factor on both measures (OR 1.46 and 2.02, both p <0.01). Teaching hospitals were associated with a higher transfusion rate (OR 1.75), and comorbidities of chronic lung disease, chronic renal failure and malignancy were related to complication rates (OR 1.89, 2.32 and 1.50, respectively).
  
  
  CONCLUSIONS
  The mortality rate of transurethral prostatic surgery is extremely low and is not affected by hospital volume. However, higher surgical volumes and laser use were significantly associated with lower rates of complications and transfusions.
authors.affiliation: School of Public Health, The University of Tokyo, Tokyo, Japan. ezy04707@nifty.com
authors.forename: Toru
authors.initials: T
authors.lastname: Sugihara
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nishimatsu
authors.forename: Haruki
authors.initials: H
authors.lastname: Kume
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D000368:Aged; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D053685:Laser Therapy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011470:Prostatic Hyperplasia / Q000601:surgery*; D020728:Transurethral Resection of Prostate / Q000009:adverse effects* / Q000401:mortality*