Day-case surgery is possible in the majority of men undergoing transurethral resection of the prostate – a report on over 1000 cases

Abstract

Objective: We describe our experience of performing bipolar transurethral resection in saline (Olympus Medical) as a day-case procedure over an initial five-year period. Patients and methods: All procedures coded as transurethral resection of the prostate over a 60-month period were analysed to determine whether the procedure was planned as a day-case or as an inpatient admission, and whether postoperative discharge proceeded as intended. Re-admission rates, reasons for re-admission and transfusion rates were also recorded. Results: Of the 1035 operations, 689 (66.57%) were planned as a day-case procedure (mean age 70.5 years) with 176 (25.5%) requiring inpatient admission, and 346 (33.43%) were planned for inpatient admission (mean age 73.6) but 58 (16.8%) were discharged the same day. Overall 571 (55.17%) procedures were performed as day cases. Readmission rates for day-case and inpatient procedures were 7.4%, and 6.3% respectively (p=0.48). Transfusion rates were lower in the day-case group (0.7% vs 3.7%, p<0.05). Day-case rates improved from 48.70% in 2011 to 75.22% in 2016. Conversion from day case to inpatient fell from 34.6% in 2011 to 14.8% in 2016. Conclusions: Our experience indicates that day-case transurethral resection of the prostate can be performed safely in appropriately selected patients, without increased rates of re-admission or complications. Level of evidence: 4 (Oxford Centre for Evidence-Based Medicine (CEBM)).

Day Case Mini Percutaneous Nephrolithotomy (PCN): First UK Experience

“…9 These pressures are compounded by problems with the availability of inpatient beds which has resulted in planned surgical cases being cancelled on the day of surgery, especially if the indication for the surgical procedure is a benign disease. Partly in response to these pressures more than 90% of our ureteroscopic surgery, 75.2% of our bladder outflow obstruction surgery 17 and 80.1% of our bladder tumour resections are already performed on a day case basis 18 . As a consequence, all facets of our day case pathway, including our waiting list team, preoperative assessment service, and a dedicated urology rapid access clinic staffed by skilled urology nurse practitioners, function in an integrated way and are highly experienced.…”

“…The importance of this should not be underestimated in achieving successful day case surgery ( and may affect other units ability to replicate our experience. 17,18 The recently published review of the MIP system by NICE has shown a cost-benefit of £800.00 when performed as an inpatient procedure compared to standard PCNL. Our cost analysis has shown a broadly similar cost-benefit when comparing both modalities.…”

UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance Update

“…The EAC explored the effect of applying to bTURP a reduced length of hospital stay of 0.5 days, reflecting day-case surgery, based on published evidence [ 27 ]. The effect was minimal, with UroLift remaining cost saving relative to all comparators.…”

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

“…A variety of options now exist to treat benign prostatic enlargement, each with slightly different anticipated long-term efficacy, and sideeffect and risk profiles [5]. There is increasing recognition that TURP and laser enucleation of the prostate can be delivered as day-case procedures within well designed pathways [6,7]. Local anaesthetic treatment options exist and many treatments have been shown to be amenable to being performed as day-case operations [8,9].…”