BPH Surgery Outcomes Worse for Older, Non-Caucasian Men

Study suggests that low preoperative hematocrit and albumin levels predict adverse outcomes.
Study suggests that low preoperative hematocrit and albumin levels predict adverse outcomes.

Advanced age, non-Caucasian race, and low preoperative hematocrit and albumin levels predict adverse outcomes following surgery for benign prostatic hyperplasia (BPH), according to a study.

In a study of 7,359 men who underwent BPH surgery, each 1 year increment in patient age was independently associated with a significant 3% increased risk of complications, a significant 10% increased risk of perioperative mortality, and a 1% increased likelihood of a prolonged (2 days or more) length of stay (pLOS), researchers reported online ahead of print in the Journal of Endourology. Non-Caucasian race was independently associated with a significant 55% increased risk of complications compared with Caucasian race.

“In patients with these attributes, conservative treatment might be a reasonable alternative,” the authors concluded.

A preoperative albumin level greater than 3.5 g/dL was associated with a significant 59% decreased risk of complications and 87% decreased risk of perioperative mortality compared with a preoperative level below 2.5 g/dL. Compared with a preoperative hematocrit below 30%, a preoperative hematocrit of 30%-45% and above 45% was associated with a significant 70% and 71% decreased likelihood of pLOS, respectively. A preoperative hematocrit of 30%-45% was associated with a significant 91% decreased likelihood of a needing a blood transfusion and a significant 79% decreased risk of perioperative mortality.

The investigators noted that prior studies have shown that low hematocrit is associated with chronic inflammatory disease states and infectious processes and has also been shown to increase mortality in patients undergoing hemodialysis. “Therefore, it is possible that patients with BPH and low hematocrit have a combination of chronic prostatic inflammation and lower hemoglobin, which may place them at risk of perioperative mortality,” they wrote.

They concluded that “preoperative hematocrit and albumin levels represent reliable serum markers for prediction of adverse outcomes, suggesting that these markers should be evaluated before BPH surgery.”

Using data from the American College of Surgeons National Surgical-Quality Improvement Program database, Naeem Bhojani, MD, and Giorgio Gandaglia, MD, of the Centre Hospitalier de l'Université de Montreal, and collaborators examined the morbidity and mortality after BPH surgery evaluated outcomes after transurethral resection of the prostate (TURP), laser vaporization of the prostate (LVP), and laser enucleation of the prostate (LEP). The study population included 4,794, 2,439, and 126 men who underwent TURP, LVP, and LEP, respectively.

The researchers found no significant difference in overall complication rates or perioperative mortality among the three surgical groups. The overall complication rates associated with TURP, LVP, and LEP were 6.5%, 6.4%, and 3.2%, respectively.

Compared with TURP, LVP and LEP were associated with a significant 88% and 65% decreased likelihood of a pLOS, respectively. Patients in the TURP and LEP groups did not differ significantly in the likelihood of requiring re-intervention and blood transfusions, but LVP patients had a significant 37% and 79% decreased risk of re-intervention and blood transfusion compared with the TURP group.

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