Can we increase bladder outlet obstruction surgery day case rates to tackle the post-Covid Elective Recovery?

ABSTRACT

Introduction: There is growing recognition that bladder outlet obstruction (BOO) surgery can often be safely performed as a day case procedure. The BOO surgery day case rate (DCR) is a Getting It Right First Time (GIRFT) quality metric. Patients awaiting BOO surgery represent the largest group awaiting elective surgical treatment in urology. This unmet need has expanded considerably due to the Covid-19 pandemic. Patients and Methods: Model Hospital (MH) is a datadriven improvement tool for English NHS trusts, which utilises routinely collected national level data. MH describes performance metrics for transurethral resection of prostate, laser prostatectomy, prostatic urethral lift, and bladder neck incision. MH data were analysed for all 115 trusts performing BOO surgery over 12 months to October 2021. Associations between service delivery and outcome metrics were tested. Results: Table 1 shows national Trust-level metrics for DCR, length of stay (LOS), 30-day readmission rate (30D), annual centre volume (ACV), and waiting list time (WLT). Analysis indicated no significant association between any of the following;DCR and 30D (Spearman rank correlation coefficient (rs)=-0.085, p=0.37), ACV and 30D (rs=- 0.019, p=0.84), DCR and WLT (rs=0.16, p=0.096). Conclusion: There is wide variation in DCR and WLT nationally. The absence of association between DCR and 30D suggests that many trusts can safely increase DCR for BOO surgery. Optimising DCR could help to facilitate the post-Covid Elective Recovery for surgery. The lack of association between DCR and WLT, however, suggests that further resource constraints beyond elective inpatient bed availability influence the provision of BOO surgery.