Agarwal Deepak K, Large Tim, Tong Yan, Stoughton Christa L, Damler Erica M, Nottingham Charles U, Rivera Marcelino E, Krambeck Amy E
Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
Eur Urol Focus. 2022 Jan;8(1):228-234. doi: 10.1016/j.euf.2020.12.018. Epub 2021 Jan 4.
Limited research has focused on success with hospital discharge on the same day of surgery after holmium laser enucleation of the prostate (HoLEP).
To determine the success of same-day discharge in our HoLEP cohort and factors associated with this approach.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of our prospectively maintained HoLEP database demonstrated that 473 adult males underwent HoLEP from July 2018 to December 2019 at a tertiary referral center and high-volume HoLEP hospital. Patients were divided into groups according to planned inpatient admission (PIA), successful same-day discharge (SDD), or unplanned admission (UA).
The PIA, SDD, and UA groups were assessed for differences in preoperative demographic data, perioperative surgical data, and postoperative follow-up data. SDD and UA were then compared to determine if any specific factors predicted UA, including univariate and multivariate logistic regression analyses.
Age (p = 0.0049), use of anticoagulation (p = 0.037), American Society of Anesthesiologists score of 3-4 (p = 0.0017), and enucleation time (p=0.0178) were significantly higher in the PIA group. Morcellation time (p = 0.0059) and the rate of bedside catheter irrigation (p = 0.04) were higher in the UA group. The SDD group had the highest rate of successful voiding trial (p = 0.0001). Among the three groups, there was no difference in the rate of postoperative complications (p = 0.141). In a comparison of the SDD and UA groups, morcellation time (p = 0.041), the rate of bedside clot evacuation (p = 0.004), and successful voiding trial (p = 0.003) all favored SDD. There was no difference in 90-d complications (p = 0.536). A limitation is the retrospective nature of this study.
HoLEP can be successfully performed as day surgery without an increase in postoperative complications. HoLEP as day surgery is possible for any patient who does not require admission for medical comorbidities.
Same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) is possible and is successful in 87.4% of patients. Patients with longer morcellation times and with post-procedure hematuria with clots are more likely to have an unplanned admission. Use of a 120-W modulated-pulse laser resulted in a higher rate of SDD success. The culture change to day surgery is time-intensive owing to education of the postsurgical care units and clinic staff, and in our experience took approximately 9 mo to seamlessly integrate SDD as our HoLEP standard of care.
关于钬激光前列腺剜除术（HoLEP）后在手术当天出院成功的研究有限。
确定我们的HoLEP队列中当日出院的成功率以及与该方法相关的因素。
设计、设置和参与者：对我们前瞻性维护的HoLEP数据库进行回顾性分析，结果显示，2018年7月至2019年12月期间，473名成年男性在一家三级转诊中心和高容量HoLEP医院接受了HoLEP手术。患者根据计划住院（PIA）、成功当日出院（SDD）或非计划住院（UA）进行分组。
对PIA、SDD和UA组的术前人口统计学数据、围手术期手术数据和术后随访数据的差异进行评估。然后比较SDD和UA，以确定是否有任何特定因素可预测UA，包括单因素和多因素逻辑回归分析。
PIA组的年龄（p = 0.0049）、抗凝剂使用情况（p = 0.037）、美国麻醉医师协会评分为3 - 4分（p = 0.0017）和剜除时间（p = 0.0178）显著更高。UA组的粉碎时间（p = 0.0059）和床边导管冲洗率（p = 0.04）更高。SDD组的排尿试验成功率最高（p = 0.0001）。三组之间术后并发症发生率无差异（p = 0.141）。在SDD组和UA组的比较中，粉碎时间（p = 0.041）、床边血块清除率（p = 0.004）和排尿试验成功率（p = 0.003）均有利于SDD。90天并发症发生率无差异（p = 0.536）。本研究的局限性在于其回顾性。
HoLEP可以作为日间手术成功进行，且术后并发症不会增加。对于任何因合并症无需住院的患者，HoLEP作为日间手术都是可行的。
钬激光前列腺剜除术（HoLEP）后当日出院（SDD）是可行的，87.4%的患者成功实现。粉碎时间较长以及术后有血凝块血尿的患者更有可能非计划住院。使用120瓦调制脉冲激光可提高SDD成功率。由于需要对术后护理单元和门诊工作人员进行培训，向日间手术的转变耗时较长，根据我们的经验，大约需要9个月才能将SDD无缝整合为我们HoLEP的标准护理方式。
