TRANSURETHRAL RESECTION OF THE PROSTATE AMONG MEDICARE BENEFICIARIES IN THE UNITED-STATES - TIME TRENDS AND OUTCOMES

Objectives. The purpose of this study was to examine the epidemiology of transurethral resection of the prostate (TURP) and associated risks among Medicare beneficiaries during the period of 1984 to 1990. Metho ds. Medicare hospital claims for a 20% national sample of Medicare ben eficiaries were used to identify TURPs performed during the study peri od. All reported rates were adjusted to the composition of the 1990 Me dicare population. Risks of mortality and reoperation were evaluated u sing life-table methods. Results. The age-adjusted rate of TURF reache d a peak in 1987 and declined thereafter. Similar trends were observed for all age groups. In 1990, the rates of TURF (including all indicat ions) were approximately 25, 19, and 13 per 1000 for men over the age of 75, 70 to 74, and 65 to 69, respectively. The 30-day mortality foll owing TURF for the treatment of benign prostatic hyperplasia (BPH) dec reased from 1.20% in 1984 to 0.77% in 1990 (linear trend, p = 0.0001). The cumulative incidence of a second TURF among men with BPH has like wise decreased steadily over time; in this study, the average was 7.2% over 7 years (5.5% when the indication for the second TURF was restri cted to BPH only). Conclusions. The rate of TURF has been declining si nce 1987, conceivably due to increasing availability of alternative tr eatments or changes in treatment preferences of patients and physician s. Over the same period, the outcomes following TURPs have improved, p erhaps due to improved surgical care and changes in patient selection.