Cost Analysis of Surgical Approaches Performed by Residents for Bladder Outlet Obstruction: Laser versus Loop

Purpose: Few studies have analyzed cost differences between holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP), and none as regards resident training. We compared these costs at a teaching institution with residents from two Boston programs. Methods: We reviewed all patients who underwent TURP (January 2007-August 2010) or HoLEP (April 2008-August 2010) with residents, excluding those with prostate cancer, simultaneous procedures at the same time, or prior urethral procedures. Operative approach was determined following consultation between the senior resident and the attending surgeon. Operative, postoperative, and urologic follow-up costs were captured and analyzed from day of surgery to 6 months post-operatively. Costs were calculated by the Department of Decision Support Services. Results: 38 HoLEP and 23 TURP patients met inclusion criteria. The two groups were comparable with the exception of higher ASA score and anticoagulation use in the HoLEP group. Despite a decreased hospital stay (0.42 vs. 1.25 days), total costs for HoLEP were higher than TURP ($8380.00 vs. $5861.78, p < 0.05) due to higher operative times (123 min vs. 74 min, p < 0.05), resulting in higher operative costs ($6768.14 vs. $3853.35, p < 0.05). Conclusions: HoLEP costs are higher than TURP from longer operative times and higher intraoperative costs, partly due to resident teaching. However, senior residents more often selected HoLEP for medically complex and/or anticoagulated patients. Despite resident inexperience with HoLEP, the complication rate remained low. Higher costs must be weighed against HoLEP benefits, which include less morbidity, shorter hospital stays and faster recovery times.