Comparison of patients undergoing laser vaporization of the prostate versus TURP using the ACS-NSQIP database

BACKGROUND: The introduction of laser therapies for the management of bladder outlet obstruction in men with BPH has challenged the gold standard treatment, TURP. We sought to compare the changing clinical characteristics of patients undergoing TURP and laser vaporization of the prostate (LVP) over time. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for men who underwent TURP and LVP from 2007 to 2012. Patient demographics, clinical and intraoperative characteristics and 30-day postoperative outcomes were analyzed. RESULTS: In all, 12 645 men met inclusion criteria, of whom 65% underwent TURP and 35% underwent LVP. Overall, men undergoing TURP were more likely to be scheduled as an emergency (3% vs 1%, P < 0.001), have shorter operative times (53 vs 56 min, P < 0.001), longer hospital stays (2.4 vs 1.0 days, P < 0.001), more frequent blood transfusions (2.1% vs 0.6%, P < 0.001) and more postoperative complications including: pneumonia (0.5% vs 0.3%, P = 0.02), septic shock (0.3% vs 0.1%, P = 0.045), and reoperation within 30 days (2.2% vs 1.4%, P = 0.06). However, between 2007 and 2012, there was a significant trend for men undergoing TURP to have increased functional independence (93-96%, P < 0.01) and American Society of Anesthesiology (ASA) Physical Class I categorization (0.6-5.1%, P < 0.001). In contrast, over the same time period, there was a trend for men undergoing LVP to be significantly older (71-73 years, P < 0.001) and have an increased hospital stay (0.50 days to 1.30 days, P = 0.03). CONCLUSIONS: Statistically significant differences in clinical characteristics of patients undergoing TURP and LVP have historically existed. However, since 2007, the characteristics of patients undergoing LVP and TURP have changed significantly. Further studies are required to compare these patient characteristics with specific urologic variables and to evaluate clinically significant changes in these cohorts.