Introduction of laser technology and procedure use for benign prostatic hyperplasia: data from Florida

Abstract

Objective: To examine the association of laser technology adoption in a market with surgery rates for benign prostatic hyperplasia.

Methods: Using the Florida files from the State Ambulatory and Inpatient Surgery Databases (2001-2009), we identified all patients who underwent transurethral surgery for benign prostatic hyperplasia. We calculated rates of benign prostatic hyperplasia surgery for all markets within the state (defined by Hospital Service Area) over time. Markets were split into 3 categories: (1) Always offering, (2) never offering, or (3) initially not offering but adopting laser prostatectomy after 2001. We used multivariable regression models to estimate surgery rates adjusted for other market characteristics. Interaction terms were included in the models to examine differences in time trends between market categories.

Results: After adjusting for market characteristics, time trends differed by market category (P < .001). Surgery rates decreased from 318 to 248 procedures per 100,000 men in markets always offering laser prostatectomy (P < .001). Markets never offering laser surgery had much lower rates that remained stable (180-187 procedures per 100,000 men, P = .805). In markets adopting laser technology, rates increased from 268 to 296 procedures per 100,000 men after adoption (P = .044), such that 4 years after adoption these markets had the highest rates among the 3 categories.

Conclusion: Adoption of laser technology is associated with rising rates of surgical intervention for benign prostatic hyperplasia. This trend appears to be induced by the introduction of laser surgery.

Figure 1

Yearly population-based rates of BPH surgery in Florida by Hospital Service Area category.

Figure 2

Adjusted population-based rates of BPH surgery after the adoption of laser prostatectomy or study midpoint. Rates were adjusted for market characteristics (median male population age, median household income, number of urologists per 100,000 population, number of hospital beds per 100,000 population, proportion of urologists 55 years old and older, proportion of the population being Caucasian, having less than a high-school education, and having a urban residence). Baseline rate in year 0 corresponds to the average across years during the study period before the adoption of laser prostatectomy for HSAs that adopted laser prostatectomy and to the average across years in the first half of the study period for the other 2 categories of HSAs.