Comparing Outcomes of Laser Enucleation of Prostate with Robotic and Open Simple Prostatectomy in Octogenarians: Insights from NSQIP

Abstract

Introduction:

Octogenarians undergoing surgical management for benign prostatic obstruction (BPO) present unique challenges because of age-related comorbidities and frailty, which may impact perioperative outcomes. This study evaluates 30-day complications in octogenarian patients undergoing laser enucleation of prostate (LEP), robotic simple prostatectomy (RSP), and open simple prostatectomy (OSP) as reported in a large U.S. national database.

Methods:

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for octogenarian patients who underwent BPO surgery from 2010 to 2023. Procedures were categorized using Current Procedural Terminology codes. Outcomes assessed included 30-day complications, readmission, and reoperation.

Results:

Of 136,991 patients undergoing BPO surgery, 1,798 were octogenarians (LEP = 1,222; RSP = 93; OSP = 483). LEP patients had shorter median operative times (94 vs 123 and 153 minutes, p < 0.0001), shorter hospital stays (1 vs 3–6 days, p < 0.0001), and higher rates of discharge to home (96.8% vs 85.3%, p = 0.016). Transfusions were more frequent after OSP (27.5% vs 3.2%, p < 0.0001). Urinary tract infections were more common following RSP (9.7% vs 3.7–5.8%, p = 0.009). OSP was associated with higher rates of return to the operating room (4.6% vs 1.1–2.3%, p = 0.023) and prolonged hospitalization beyond 30 days (3.4% vs 0–1.5%, p = 0.016). Independent predictors of complications included higher ASA class, dependent functional status, longer operative time, and undergoing OSP vs LEP.

Conclusion:

LEP demonstrated superior perioperative outcomes with shorter operative times, lower transfusion rates, and a higher likelihood of discharge to home, supporting its preference in octogenarians. RSP provided intermediate outcomes, whereas OSP was associated with the highest morbidity.