Introduction: Holmium laser enucleation of the prostate (HoLEP) has evidenced-based advantages in treating benign prostatic hyperplasia (BPH) relative to other interventions. Unfortunately, the adoption of HoLEP has remained relatively low in Medicare and the National Surgical Quality Improvement Program populations. HoLEPs role as an inpatient surgical intervention is changing as advancements in the technique and systems have demonstrated the feasibility of same-day discharge. Thus, our objective was to evaluate national HoLEP trends in ambulatory surgery settings from 2016 to 2019. Materials and Methods: The Nationwide Ambulatory Surgery Sample (NASS) is the largest national all-payer database of ambulatory surgical encounters, managed by the Agency for Healthcare Research and Quality. A cross-sectional retrospective analysis of the 2016 and 2019 NASS was performed. Rates of BPH surgeries were calculated and stratified by age, census region, and primary payer to compare across time points for trends. Chi-squared tests and two-sample t-tests were completed for categorical and continuous variables, respectively. Results: The total number of ambulatory BPH surgeries fell 20% between 2016 (n = 124,538) and 2019 (n = 100,593). In 2016, HoLEP lagged behind photoselective vaporization of the prostate (PVP) and transurethral resection of prostate (TURP) with 4.7% of surgeries but rose to the second most common procedure in 2019 with 8.3% of total surgeries. TURP was the most common intervention (62.6% in 2016, 90.7% in 2019). Simple prostatectomy was the most expensive intervention. By U.S. census region, more HoLEPs were carried out in the South (43.1% in 2016, 37.5% in 2019) and Midwest (26.8% in 2016, 31.7% in 2019). Conclusions: Overall, HoLEP uptake is increasing. HoLEP has replaced greenlight PVP as the second most frequently used intervention. The rate of ambulatory HoLEPs has nearly doubled despite a general decrease in the number of surgeries.

中文翻译：

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门诊手术中良性前列腺增生手术的趋势。

简介：相对于其他干预措施，钬激光前列腺剜除术 (HoLEP) 在治疗良性前列腺增生 (BPH) 方面具有明显的优势。不幸的是，HoLEP 在医疗保险和国家手术质量改进计划人群中的采用率仍然相对较低。随着技术和系统的进步证明了当天出院的可行性，HoLEP 作为住院手术干预的作用正在发生变化。因此，我们的目标是评估 2016 年至 2019 年全国门诊手术环境中的 HoLEP 趋势。材料和方法：全国门诊手术样本 (NASS) 是最大的全国门诊手术病例数据库，由医疗保健机构管理研究和质量。对 2016 年和 2019 年 NASS 进行了横断面回顾性分析。根据年龄、人口普查地区和主要付款人计算和分层前列腺增生症手术率，以比较不同时间点的趋势。分别对分类变量和连续变量完成卡方检验和双样本 t 检验。结果：2016 年 (n = 124,538) 至 2019 年 (n = 100,593) 期间，门诊 BPH 手术总数下降了 20%。2016 年，HoLEP 落后于光选择性前列腺汽化术 (PVP) 和经尿道前列腺电切术 (TURP)，占手术总数的 4.7%，但在 2019 年上升到第二位最常见的手术，占手术总数的 8.3%。TURP 是最常见的干预措施（2016 年为 62.6%，2019 年为 90.7%）。简单的前列腺切除术是最昂贵的干预措施。按美国人口普查地区划分，南部（2016 年为 43.1%，2019 年为 37.5%）和中西部（2016 年为 26.8%，2019 年为 31.7%）进行了更多的 HoLEP。结论：总体而言，HoLEP 的采用率正在增加。HoLEP 已取代绿灯 PVP 成为第二常用的干预措施。尽管手术数量普遍减少，但门诊 HoLEP 的发生率几乎翻了一番。