Category: Epidemiology, Health Policy, Socioeconomics & Outcomes
Introduction & Objective : Centres performing TURP in high volume (>250 cases per year) will subject patients to average surgical times of 60 to 90 minutes and hospital stay up to 3-4 days. In our institution this is linked to observed associated financial losses of over £110 000 per annum. Recent technical innovations have allowed us to revise our BPH pathway to incorporate more ambulatory and day care surgery. This study aims to evaluate the impact and safety of incoporating both Urolift and day-case bipolar TURP using Patient Level Income Costing Software (PLICS).
Methods : PLICS data compared patient and surgical outcomes at the begining and end of the implentation period for the change of service for treating men with BPH at our centre. We interogated this database using standard HRG codes and updated the software to improve accuracy of unknown variables such as equipment costs and discharge times. We recorded all 30 day complications and outcomes of surgery based on successful trial with cathteter (TWOC) and follow up IPSS questionnaire. We constructed an economic model to analyse the impact of Urolift versus b-TURP.
Results : Length of Stay reduced from 3 to 1.9 days in under 18 months. Mean operative time for TURP (47 mins) and Urolift (9 mins). There was no observed increase in 30-day complication rates despite adopting our new fast-track discharge process. Immediately, we observed 42% reduction in costs associated to TURP surgery. Also, we have calculated that by incorporating Urolift into the surgical pathway at a ratio of 1:1 (i.e. 50% of all BPH surgeries per year), we will generate additional annual savings of £42 000. By adopting more Urolift surgeries we also will save 300 additional bed days and 106 additional hours of operating theatre time each year.
Conclusions : Providing dedicated day-case BPH services allowed us to achieve a positive service change without financial investment or observing any increase in complications. Additional capacity allows for our department to focus on critical cancer targets and waiting times; whilst reducing delays in both urgent and non-urgent surgery.