title: Trends and Utilization of Laser Prostatectomy in Ambulatory Surgical Procedures for the Treatment of Benign Prostatic Hyperplasia in New York State (2000-2011).
abstract: BACKGROUND
  There has been a significant change in surgical treatment of benign prostatic hypertrophy (BPH) over the last two decades. Most importantly, laser surgery (coagulation, vaporization, or enucleation) has been growing in popularity as an alternative to standard transurethral prostatectomy (TURP) or other procedures. Our goal was to analyze the trends of BPH surgeries and compare outcomes of laser surgery to TURP, the two most common alternative surgeries.
  
  
  METHODS
  We used the New York Statewide Planning and Research Cooperation System (SPARCS) data to identify patients diagnosed as having BPH who underwent BPH-related surgery from October 2000 to December 2011. Age, insurance, individual comorbidities, and average hospital volumes were assessed. Bivariate and multivariate regression models were used to analyze predictors of laser use. In-hospital outcomes were then compared between laser and TURP in a balanced propensity-matched cohort.
  
  
  RESULTS
  Ninety thousand six hundred seventy patients underwent BPH surgery. Laser surgery usage increased from 6.4% to 44.5% over 10 years (p<0.0001). TURP declined significantly from 72.2% to 48.3% (p<0.0001). Patients with Medicaid were less likely to undergo laser therapy than those with private insurance (odds ratio [OR]: 0.58, 95% confidence interval [CI]: 0.48, 0.69). Mid- and high-volume institutions were more likely to use laser treatment than low-volume centers (OR: 2.26, 95% CI: 1.22, 4.2; OR: 4.07, 95% CI: 1.75, 9.46, respectively). In the matched cohort, both laser and TURP patients had similar complication rates with more frequent electrolyte disorders in TURP patients (2.9% vs 2.3%, p=0.001).
  
  
  CONCLUSIONS
  TURP remains the most common procedure. However, the rate of use has declined over time. In contrast, laser use has significantly increased. Laser treatment was utilized more in younger patients, in those privately insured, in hospitals with high volumes of BPH procedures, and in patients with fewer comorbid conditions. Both surgeries are safe with no differences in terms of occurrences of morbidity and complications.
authors.affiliation: 1 Department of Urology, Weill Medical College of Cornell University , New York, New York.
authors.forename: Bilal I
authors.initials: BI
authors.lastname: Chughtai
authors.affiliation: 1 Department of Urology, Weill Medical College of Cornell University , New York, New York.
authors.forename: Vannita
authors.initials: V
authors.lastname: Simma-Chiang
authors.affiliation: 1 Department of Urology, Weill Medical College of Cornell University , New York, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.affiliation: 2 Department of Healthcare Policy and Research, Weill Medical College of Cornell University , New York, New York.
authors.forename: Abby
authors.initials: A
authors.lastname: Isaacs
authors.affiliation: 1 Department of Urology, Weill Medical College of Cornell University , New York, New York.
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Te
authors.affiliation: 1 Department of Urology, Weill Medical College of Cornell University , New York, New York.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kaplan
authors.affiliation: 2 Department of Healthcare Policy and Research, Weill Medical College of Cornell University , New York, New York.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D053685:Laser Therapy / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D009518:New York; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D011470:Prostatic Hyperplasia / Q000601:surgery*; D020728:Transurethral Resection of Prostate / Q000379:methods / Q000706:statistics & numerical data*