HoLEP Safety and Efficacy in Octogenarians: A Retrospective ACS-NSQIP Analysis (2011-2020)

Emad Eddin Dalla; Mukund Bhandari; Ahmad Abdelaziz; Shaun Trecarten; Michael Liss; Ahmed M Mansour

doi:10.1016/j.urology.2024.10.070

HoLEP Safety and Efficacy in Octogenarians: A Retrospective ACS-NSQIP Analysis (2011-2020)

Urology. 2024 Dec 4:S0090-4295(24)00971-3. doi: 10.1016/j.urology.2024.10.070. Online ahead of print.

Authors

Emad Eddin Dalla¹, Mukund Bhandari², Ahmad Abdelaziz¹, Shaun Trecarten¹, Michael Liss¹, Ahmed M Mansour³

Affiliations

¹ The University of Texas Health Science Center at San Antonio, Urology, San Antonio, TX.
² The University of Texas Health Science Center at San Antonio, Department of Population Health Sciences, San Antonio, TX.
³ The University of Texas Health Science Center at San Antonio, Urology, San Antonio, TX; Mansoura University Urology and Nephrology Center, Mansoura, Egypt. Electronic address: [email protected].

PMID: 39643049
DOI: 10.1016/j.urology.2024.10.070

Abstract

Objective: To evaluate the safety of Holmium laser enucleation of the prostate (HoLEP) in octogenarian compared to non-octogenarian patients.

Methods: A retrospective cohort analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2020. We assessed baseline demographic data, American Society of Anesthesiologists (ASA) score, functional status, and medical comorbidities. Our primary outcome was the incidence of postoperative complications, the need for re-operation, and readmission within 30 days following the procedure between octogenarians and non-octogenarians. A multivariate logistic model was utilized to identify predictors for postoperative complications.

Results: A total of 5305 patients were included. Octogenarians had higher rates of hypertension (69.9% vs 55.5%, P<.001), and bleeding disorders (5.1% vs 2.6%, P<.001). The absolute risk for postoperative complications was low in the 2 groups. However, the octogenarians had higher rates for readmitted (6.1% vs 3.6% P=.006) and to receive perioperative blood transfusion (3.3% vs 0.9% P-value <.001). Multivariable regression analysis showed a significantly lower odds ratio to develop complications in non-octogenarians (OR: 0.698) (95% CI: 0.537, 0.908, [P=.007]).

Conclusion: There was a significant association between octogenarians and the risk of postoperative complications of HoLEP, however, the absolute risk remained low. We believe that operative outcomes for octogenarians can be optimized with careful selection given the low incidence of complications.