title: Morbidity and mortality after benign prostatic hyperplasia surgery: data from the American College of Surgeons national surgical quality improvement program.
abstract: OBJECTIVE
  With the aging population, it is becoming increasingly important to identify patients at risk for postsurgical complications who might be more suited for conservative treatment. We sought to identify predictors of morbidity after surgical treatment of benign prostatic hyperplasia (BPH) using a large national contemporary population-based cohort.
  
  
  METHODS
  Relying on the American College of Surgeons National Surgical-Quality Improvement Program (ACS-NSQIP; 2006-2011) database, we evaluated outcomes after transurethral resection of the prostate (TURP), laser vaporization of the prostate (LVP), and laser enucleation of the prostate (LEP). Outcomes included blood-transfusion rates, length of stay, complications, reintervention rates, and perioperative mortality. Multivariable logistic-regression analysis evaluated the predictors of perioperative morbidity and mortality.
  
  
  RESULTS
  Overall, 4794 (65.2%), 2439 (33.1%), and 126 (1.7%) patients underwent TURP, LVP, and LEP, respectively. No significant difference in overall complications (P=0.3) or perioperative mortality (P=0.5) between the three surgical groups was found. LVP was found to be associated with decreased blood transfusions (odds ratio [OR]=0.21; P=0.001), length of stay (OR=0.12; P<0.001) and reintervention rates (OR=0.63; P=0.02). LEP was found to be associated with decreased prolonged length of stay (OR=0.35; P=0.01). Men with advanced age at surgery and non-Caucasians were at increased risk of morbidity and mortality. In contrast, normal preoperative albumin and higher preoperative hematocrit (>30%) levels were the only predictors of lower overall complications and perioperative mortality.
  
  
  CONCLUSIONS
  All three surgical modalities for BPH management were found to be safe. Advanced age and non-Caucasian race were independent predictors of adverse outcomes after BPH surgery. In patients with these attributes, conservative treatment might be a reasonable alternative. Also, preoperative hematocrit and albumin levels represent reliable predictors of adverse outcomes, suggesting that these markers should be evaluated before BPH surgery.
authors: 1 Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal , Montreal, Quebec, Canada.
authors: Naeem
authors: N
authors: Bhojani
authors: Giorgio
authors: G
authors: Gandaglia
authors: Akshay
authors: A
authors: Sood
authors: Arun
authors: A
authors: Rai
authors: Daniel
authors: D
authors: Pucheril
authors: Steven L
authors: SL
authors: Chang
authors: Pierre I
authors: PI
authors: Karakiewicz
authors: Mani
authors: M
authors: Menon
authors: Kola
authors: K
authors: Olugbade
authors: Nedim
authors: N
authors: Ruhotina
authors: Jesse D
authors: JD
authors: Sammon
authors: Shyam
authors: S
authors: Sukumar
authors: Maxine
authors: M
authors: Sun
authors: Khurshid R
authors: KR
authors: Ghani
authors: Marianne
authors: M
authors: Schmid
authors: Briony
authors: B
authors: Varda
authors: Adam S
authors: AS
authors: Kibel
authors: Kevin C
authors: KC
authors: Zorn
authors: Quoc-Dien
authors: QD
authors: Trinh
mesh_terms: D000367:Age Factors; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016208:Databases, Factual / Q000706:statistics & numerical data*; D006400:Hematocrit; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects* / Q000401:mortality; D007902:Length of Stay; D008297:Male; D009017:Morbidity; D016017:Odds Ratio; D011470:Prostatic Hyperplasia / Q000097:blood / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D058996:Quality Improvement; D012044:Regression Analysis; D012086:Reoperation / Q000706:statistics & numerical data; D012709:Serum Albumin / Q000032:analysis; D012955:Societies, Medical / Q000706:statistics & numerical data; D020728:Transurethral Resection of Prostate / Q000009:adverse effects* / Q000401:mortality; D014481:United States
chemical_list: D012709:Serum Albumin