Ambulatory-based bladder outlet procedures offer significant cost savings and comparable 30-day outcomes relative to inpatient surgery.

Introduction and Objectives Budgetary constraints and novel minimally invasive surgical approaches have resulted in surgical care being increasingly provided at ambulatory centers rather than traditional inpatient settings. Despite increasing use of ambulatory-based surgery for bladder outlet obstruction (BOO) procedures, little is known about the effect of care setting on perioperative outcomes and costs. We sought to compare 30-day readmissions rates as well as costs of BOO surgery performed in the ambulatory vs. inpatient setting. Methods Using Florida and New York all-payer data from the 2014 Healthcare Cost and Utilization Project State Databases, we identified patients that underwent transurethral resection, thermotherapy, or laser/photovaporization for BOO. Patient demographics, regional data, 30-day readmissions rates, and costs (from converted charges) associated with the index surgery and revisits were analyzed. Predictors of 30-day revisits were also identified by fitting a multivariate logistic regression model with facility-level clustering. Results Of the 15,094 patients identified, 1,444 (9.6%) had a 30-day revisit at a median cost of $4,263.43. The 30-day readmission rate for inpatient cases was significantly higher than that of surgeries performed in the ambulatory setting (12.0% vs. 8.1%, P<0.001). Payer status (private vs. Medicare: OR 0.77, 95% CI 0.62-0.95; P=0.02) and index care setting (ambulatory vs. inpatient: OR 0.48, 95% CI 0.40-0.57; P<0.001) predicted 30-day revisits. Conclusions We identified that index care setting and payer status are independent predictors of 30-day revisit following BOO surgery, with the inpatient setting and Medicare insurance associated with higher odds of a revisit. Ambulatory surgery is significantly less costly than procedures performed in the inpatient setting, even after accounting for ambulatory procedures leading to admission. There is an obvious cost-benefit of offering BOO surgery in the ambulatory setting to the appropriate patient. In the context of value-based healthcare initiatives, our findings have important implications for policymakers seeking to reduce variation in non-clinical sources of perioperative costs and outcomes.