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

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.