HoLEP readmission low, tied to bleeding, frailty, physical status

Hospital readmission occurs infrequently after holmium enucleation of the prostate (HoLEP), a new study has found. Risk factors for readmission include bleeding and the American Society of Anesthesiologists (ASA) score.

The study included 3,489 patients (median age 70 years) who had undergone HoLEP from 2011 to 2019 for benign prostatic hyperplasia. Of the patients, 23.88 percent (n=833) were discharged within 24 hours of the procedure, while 76.12 percent (n=2,656) needed more than a day to recuperate. Outcomes and predictors of rehospitalization were also compared between subgroups.

Overall, only 158 patients were readmitted within 30 days of discharge, yielding a rate of 4.5 percent. Those readmitted were older (p=0.001) and most likely to demonstrate postoperative anaemia, chronic kidney disease, frailty and bleeding disorder (p<0.001). ASA score ≥3 was also significantly more common among those who needed repeat hospitalization (p<0.001).

Rates of complication (p=0.4) and rehospitalization (p=0.2) were not significantly different between those who were discharged <24 hours vs ≥24 hours after HoLEP.

Multivariable logistic regression analysis found that bleeding disorder increased the likelihood of readmission by nearly three times (odds ratio [OR], 2.89, 95 percent confidence interval [CI], 1.63–5.11; p<0.001). ASA score ≥3 (OR, 1.80, 95 percent CI, 1.21–2.70; p=0.004) and a score ≥2 in the 5-item modified frailty index (OR, 1.67, 95 percent CI, 1.03–2.71; p=0.038) were also significant indicators of 30-day readmission. Same-day discharge was not.