To evaluate the the incidence and predictors of hospital readmission and emergency visits in patients with benign prostatic hyperplasia treated by transurethral resection of the prostate (TURP).

We conducted a retrospective cohort study using linked administrative dataset from Calgary, Canada. Participants were men who underwent their first TURP procedure between 2015 and 2017. We examined patient demographics, and status of surgery (elective, urgent). Comorbidities were scored using the Charlson comorbidity index (CCI). The primary outcomes were unplanned hospital readmissions and emergency department visits at 30-, 60-, and 90-days after TURP surgery. The secondary outcome was to identify potential predictors across these groups.

We identified  3059 men, most of whom underwent elective TURP (83%). Mean patient age (SD) was 71.0 (10.0) years. A total of 224 (7.4%) patients were readmitted to the hospital within 30 days, 290 (9.5%) within 60 days, and 339 (11.1%) within 90 days of discharge (Table 1). The frequency of return visits within 30-, 60-, and 90-days after TURP were 21.4%, 26%, and 28.6% respectively (Table 2). The most responsible diagnosis for ED visit within 90 days were hematuria (15.4%), and retention of urine (12.8%). Multi-variable analysis revealed age (OR 1.61, p<0.001), surgery status (OR 2.20, p<0.001), and CCI (OR 2.03, p<0.001) were independently associated with odds of readmission and ED visits at all time points.

This is the first large-scale population-based cohort study in North America to compare hospital readmission and ED visits after TURP at 30-, 60-, and 90-days post-discharge. Of the 90-day ED visits, approximately one- quarter required re-hospitalization. Individuals who experienced a readmission and/or ED visit were more likely to be older, to have poorer health (higher CCI) and to have undergone urgent surgical transurethral resection of the prostate. We thus inferred that men aged 75 and older with BPH/LUTS and significant comorbidities have a higher risk of complications after urgent TURP and therefore are at higher risk of readmission and ER visits. We report that 17% of patients returning to ED had undergone an expedited (“urgent”) TURP - within 7 days of catheterization. This finding highlights the importance of ensuring that patients are fully optimized medically before their surgery.

The present study therefore strongly supports a need to implement strategies to reduce the risk of return visits to the ED and hospital readmission following TURP, both to improve health outcomes and to lessen the economic burden of care.  These strategies must involve efforts upstream, midstream and downstream of the surgical intervention. The other factor to consider is the changes in surgical management of BPH that are occurring with the use of minimally invasive technologies.

Older age, poorer health and urgent surgery predicted return to emergency department or readmission after TURP; efforts should be made to improve selection, counsel and preoperative optimization based on these risks.