Hospital caseload thresholds for improved perioperative outcomes during transurethral resection or enucleation of the prostate: results from the GRAND study

BACKGROUND: We aimed to determine a data-based annual hospital volume threshold for transurethral resection of the prostate (TURP), simple prostatectomy, holmium laser enucleation of the prostate (HoLEP), and thulium laser enucleation of the prostate (ThuLEP) and evaluate its clinical significance regarding perioperative morbidity. MATERIALS AND METHODS: We utilized the German Nationwide Inpatient Data (GRAND), provided by the Research Data Center of the Federal Statistical Office (2005-2022). Based on ROC analyses, the optimal annual hospital volume threshold to reduce perioperative incontinence, intensive care unit (ICU) admission, sepsis, transfusion, and hospital stay was identified for these surgeries. RESULTS: A total of 1,084,650 TURP cases, 90,735 simple prostatectomy cases, 64,325 HoLEP cases, and 15,241 ThuLEP cases were included. For TURP, the annual hospital volume threshold to reduce perioperative morbidity was 266 cases for incontinence, 196 for ICU admission, 279 for sepsis, 241 for transfusions, and 139 for hospital stay. For simple prostatectomy, the annual hospital volume threshold to reduce perioperative morbidity was 22 cases for incontinence, 11 for ICU admission, 26 for sepsis, 23 for transfusions, and 32 for hospital stay. For HoLEP, the annual hospital volume threshold to reduce perioperative morbidity was 290 cases for incontinence, 120 for ICU admission, 140 for sepsis, 132 for transfusions, and 180 for hospital stay. For ThuLEP, the annual hospital volume threshold to reduce perioperative morbidity was 55 cases for incontinence, 56 for ICU admission, 217 for sepsis, 331 for transfusions, and 68 for hospital stay. CONCLUSION: The annual hospital volume threshold for improving perioperative outcomes in BPH surgery is high. Thus, centralization of benign prostatic hyperplasia surgery may be mandatory in some cases.