Travel characteristics and outcomes for patients seeking HoLEP

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) is an effective but underutilized option for the surgical management of benign prostatic hyperplasia (BPH). With low adoption, questions arise surrounding patients access to care. It is unclear whether patients undergoing HoLEP are local or specifically seek care from afar. We looked to determine the proportion of patients who traveled out-of-state for HoLEP treatment and the impact of travel on peri and postoperative metrics. MATERIALS AND METHODS: We performed a retrospective cohort study evaluating patients that underwent HoLEP at a single institution from 2007-2019. Patient demographic, perioperative data, postoperative outcomes, travel distance and income data were compared between those who traveled and did not travel out-of-state for care. RESULTS: From 2007-2019, 1565 patients underwent HoLEP at our institution. The mean age was 70.0 years, average body mass index (BMI) of 27.9 kg/m2, and 91.6% identified as Caucasian; 44.2% of patients traveled from out-of-state for HoLEP care, traveling a median of 597 miles. Patients who came from out-of-state had larger prostates (p = 0.005) and worse preoperative International Prostate Symptom Score (IPSS) total and bother scores (p = 0.002). There was no difference in immediate, 30 or 90 day complications rates. In- and out-of-state patients had similar postoperative urinary and functional outcomes. CONCLUSIONS: A large proportion of patients specifically seek out HoLEP and travel out-of-state for care. The reasons are likely multifactorial -including advanced disease, lack of local care and healthcare consumerism. These results have implications both for those currently providing HoLEP as a treatment option as well as those motivated to start a HoLEP practice.