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National trends of inpatient vs. outpatient male benign prostate hyperplasia procedures: 2016-2019

  • Walter Roper,
  • Joseph Marte,
  • Justin Lee,
  • Gregory Joice

Introduction and objective:

Benign prostatic hyperplasia (BPH) is a common condition among aging men, causing urinary symptoms and impacting quality of life. Evaluating the setting of procedures (inpatient vs. outpatient) and associated costs can provide valuable insights and help identify disparities in access to care. Assessing the financial implications of care settings can optimize resource allocation. This research aims to contribute to knowledge by providing insights into BPH treatment patterns, patient demographics, and healthcare costs for improved patient outcomes.


An analysis of BPH treatments performed from 2016-2019 was conducted using the National Inpatient Sample and the Nationwide Ambulatory Surgery Sample. Procedures were identified by Current Procedural Terminology (CPT) and International Classification of Diseases (10th Revision) Procedure Coding System (ICD-10-PCS) codes. Stratified cluster sampling was used to create weighted national estimates.Multivariable logistic regression was used to evaluate patient- and hospital-level factors associated with inpatient BPH treatments.


Of the 811,111 weighted BPH treatment procedures, 45% were performed inpatient and 55% were performed outpatient throughout 2016-2019. Regional analysis revealed a majority were performed in the South at 36% inpatient and 40% outpatient. Medicare was the primary payer for inpatient and outpatient settings at 51% and 60%, respectively. The mean total charge for inpatient BPH encounters was $70,061 vs. $22,716 outpatient. Multivariable logistic regression analysis showed an Elixhauser Comorbidity Index >0 as a significant predictor of inpatient BPH treatment in a dose-dependent manner (Table 1). Patient factors such as higher age and lower income and hospital factors such as Urban Non-Teaching status and high volume had lower odds of inpatient BPH encounters (Table 1).


A majority of BPH treatment procedures nationwide appear to be performed in an outpatient setting. Outpatient procedures have a lower total charge compared to inpatient care, which appears to be a contributing factor. Inpatient procedures are more likely to be performed on patients with higher Elixhauser Comorbidity Index scores. Further investigation is needed to assess how these factors affect surgical outcomes.

Tags: AUA24