Presentation Authors: David F. Friedlander*, Brighton, MA, Marieke J. Krimphove, Alexander P. Cole, Gezzer Ortega, Quoc-Dien Trinh, Boston, MA
Introduction: Surgery is an appropriate treatment option for men with bladder outlet obstruction (BOO) in whom pharmacotherapy has proven unsuccessful. Cost pressures and newer minimally invasive outlet procedures have led to a migration away from the traditional inpatient care setting toward ambulatory surgical centers. We previously demonstrated that patients undergoing BOO surgery in the inpatient setting experience higher rates of 30-day revisits compared to ambulatory procedures. In this context, we aimed to identify predictors of 30-day revisits and associated costs following BOO surgery.
Methods: All-payer data from the 2014 Healthcare Cost and Utilization Project (HCUP) State Databases from Florida (FL) and New York (NY) were used to identify all patients undergoing an index BOO procedure in the form of transurethral resection (TURP), laser/photovaporization (PVP), or thermotherapy (TUMT/TUNA). Patient demographics, regional data, 30-day revisit rates, and total charges (converted to costs) associated with revisit were determined. Multivariate logistic regression adjusted for facility clustering was utilized to identify predictors of 30-day revisit.
Results: Of the 15,094 patients undergoing a BOO procedure, 1,444 (9.6%) experienced a 30-day revisit at a median cost of $4263.43. The 30-day revisit rate for cases performed in the inpatient setting was significantly higher than ambulatory procedures (12.0% vs. 8.1%, P < 0.001). Predictors of 30-day revisit included older age (OR 1.01, 95% CI 1.00-1.02; P=0.002), higher Charlson Comorbidity Index score (CCI â‰¥2 vs. 0: OR 1.75, 95% CI 1.49-2.04; P < 0.001), payer status (private vs. Medicare: OR 0.77, 95% CI 0.62-0.95; P=0.02), median household income (â‰¥$66,000 vs. < $40,000: OR 0.72, 95% CI 0.57-0.93; P=0.004), and index care setting (ambulatory vs. inpatient: OR 0.48, 95% CI 0.40-0.57; P < 0.001).
Conclusions: We demonstrated that index care setting and payer status are independent predictors of 30-day revisit following BOO, with patients undergoing BOO surgery in the inpatient setting and those with Medicare experiencing higher revisit rates. Our findings have important policy implications in the setting of recent value-based purchasing efforts, which seek to reduce variation in non-clinical sources of perioperative costs and outcomes.
Source of Funding: Quoc-Dien Trinh is supported by the Brigham Research Institute Fund to Sustain Research Excellence, the Bruce A. Beal and Robert L. Beal Surgical Fellowship, the Genentech Bio-Oncology Career Development Award from the Conquer Cancer Foundation of the Ame