Abstract：
To describe the contemporary evolution of day-case bladder outflow obstruction (BOO) surgery in England and to profile day-case BOO surgery practices across England in terms of the types of operation performed and their safety profiles.
This was a retrospective observational analysis of Hospital Episode Statistics and UK Office for National Statistics data. All 111 043 recorded operations across 117 hospital trusts over 66 months, from 1 January 2017 to 30 June 2022, were obtained. Operations were identified as one of: transurethral resection of prostate (TURP); laser ablation or enucleation; vapour therapy; prostatic urethral lift (PUL); or bladder neck incision. Monthly day-case rate trends were plotted across the study period. Descriptive data, day-case rates and 30-day hospital readmissions were analysed for each operation type. Multilevel regression modelling with mixed effects was performed to determine whether day-case surgery was associated with higher 30-day hospital readmissions.
Day-case patients were younger, with fewer comorbidities. Time series analysis showed a linear day-case rate increase from 8.3% (January 2017) to 21.0% (June 2022). Day-case rates improved for 92/117 trusts in 2021/2022 compared with 2017. Three of the six trusts with the highest day-case rates performed predominantly day-case TURP, and the other three laser surgery. Nationally, PUL and vapour surgery had the highest day-case rates (80.9% and 38.1%). Most inpatient operations were TURP. Multilevel regression modelling found reduced odds of 30-day readmission after day-case BOO surgery (all operations pooled), no difference for day-case vs inpatient TURP, and reduced odds following day-case LASER operations.
The day-case rates for BOO surgery have linearly increased. Minimally invasive surgical technologies are commonly performed as day cases, whereas high day-case rates for TURP and for laser ablation operations are seen in a minority of hospitals. Day-case pathways to treat BOO can be safely developed irrespective of operative modality.
This was a retrospective observational analysis of Hospital Episode Statistics and UK Office for National Statistics data. All 111 043 recorded operations across 117 hospital trusts over 66 months, from 1 January 2017 to 30 June 2022, were obtained. Operations were identified as one of: transurethral resection of prostate (TURP); laser ablation or enucleation; vapour therapy; prostatic urethral lift (PUL); or bladder neck incision. Monthly day-case rate trends were plotted across the study period. Descriptive data, day-case rates and 30-day hospital readmissions were analysed for each operation type. Multilevel regression modelling with mixed effects was performed to determine whether day-case surgery was associated with higher 30-day hospital readmissions.
Day-case patients were younger, with fewer comorbidities. Time series analysis showed a linear day-case rate increase from 8.3% (January 2017) to 21.0% (June 2022). Day-case rates improved for 92/117 trusts in 2021/2022 compared with 2017. Three of the six trusts with the highest day-case rates performed predominantly day-case TURP, and the other three laser surgery. Nationally, PUL and vapour surgery had the highest day-case rates (80.9% and 38.1%). Most inpatient operations were TURP. Multilevel regression modelling found reduced odds of 30-day readmission after day-case BOO surgery (all operations pooled), no difference for day-case vs inpatient TURP, and reduced odds following day-case LASER operations.
The day-case rates for BOO surgery have linearly increased. Minimally invasive surgical technologies are commonly performed as day cases, whereas high day-case rates for TURP and for laser ablation operations are seen in a minority of hospitals. Day-case pathways to treat BOO can be safely developed irrespective of operative modality.
摘要：
目的：描述英格兰日间膀胱流出道梗阻（BOO）手术的当代演变，并根据所进行的手术类型及其安全性描述整个英格兰的日间BOO手术实践。
方法：这是对医院事件统计和英国国家统计局数据的回顾性观察分析。在66个月的时间里，117家医院信托基金中记录的所有111043例手术，从2017年1月1日至2022年6月30日，获得。手术被确定为以下之一：经尿道前列腺电切术（TURP）；激光消融或摘除术；蒸气疗法；前列腺尿道提升（PUL）；或膀胱颈切口。在研究期间绘制每月日病例率趋势。描述性数据，分析了每种手术类型的日病例率和30天的再入院率.进行了具有混合效应的多水平回归模型，以确定日间手术是否与更高的30天住院再入院率相关。
结果：日间病例患者较年轻，减少合并症。时间序列分析显示，每日病例率从8.3%(2017年1月)线性上升至21.0%(2022年6月)。与2017年相比，2021/2022年92/117信托的日费率有所提高。当日率最高的六个信托中有三个主要执行了当日率TURP，还有另外三个激光手术.在全国范围内,PUL和蒸气手术的日间病例率最高（80.9％和38.1％）。大多数住院手术是TURP。多水平回归模型发现，日间BOO手术（所有手术合并）后30天再入院的几率降低，日间病例与住院患者TURP无差异，并降低了日间激光操作后的几率。
结论：BOO手术的日例数呈线性增加。微创手术技术通常作为日间病例进行，而在少数医院中，TURP和激光消融手术的日间病例率高。无论手术方式如何，都可以安全地开发治疗BOO的日间病例途径。
方法：这是对医院事件统计和英国国家统计局数据的回顾性观察分析。在66个月的时间里，117家医院信托基金中记录的所有111043例手术，从2017年1月1日至2022年6月30日，获得。手术被确定为以下之一：经尿道前列腺电切术（TURP）；激光消融或摘除术；蒸气疗法；前列腺尿道提升（PUL）；或膀胱颈切口。在研究期间绘制每月日病例率趋势。描述性数据，分析了每种手术类型的日病例率和30天的再入院率.进行了具有混合效应的多水平回归模型，以确定日间手术是否与更高的30天住院再入院率相关。
结果：日间病例患者较年轻，减少合并症。时间序列分析显示，每日病例率从8.3%(2017年1月)线性上升至21.0%(2022年6月)。与2017年相比，2021/2022年92/117信托的日费率有所提高。当日率最高的六个信托中有三个主要执行了当日率TURP，还有另外三个激光手术.在全国范围内,PUL和蒸气手术的日间病例率最高（80.9％和38.1％）。大多数住院手术是TURP。多水平回归模型发现，日间BOO手术（所有手术合并）后30天再入院的几率降低，日间病例与住院患者TURP无差异，并降低了日间激光操作后的几率。
结论：BOO手术的日例数呈线性增加。微创手术技术通常作为日间病例进行，而在少数医院中，TURP和激光消融手术的日间病例率高。无论手术方式如何，都可以安全地开发治疗BOO的日间病例途径。
