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Prostate Biopsy Complications, a Dual Analysis

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Prostate Biopsy Complications, a Dual Analysis

Introduction

Prostate needle biopsy (PNB) is necessary for the diagnosis and prognostic evaluation of prostate cancer but is associated with some degree of risk.  Sepsis secondary to PNB has been extensively reported and most often is associated with quinolone resistant E. coli. Other serious complications, including hemorrhage and syncope have received less attention. Recent reports utilizing Administrative Claims Based Data (ACBD) have suggested an increased risk of complications associated with PNB prompting admission to the hospital (6.9%). In this report we compare serious PNB associated complications determined by an Electronic Medical Record (EMR) administrative coding based analysis and a patient questionnaire survey.

Materials and Methods

A total of 2,410 patients underwent 2,588 biopsies and were evaluated for PNB associated complications at Genesis Healthcare Partners (GHP), an Integrated Urology Group Practice (IUGP) over a 31 month period. Two approaches were used to determine the incidence and type of complications that occurred following PNB: 1) EMR analysis based on ICD-9 and CPT coding, 2) Patient reported questionnaire concerning complications following PNB. The EMR query was performed by a software program.

Results

 The EMR coding based analysis of 2,588 biopsies revealed 69 (2.67%) serious complications leading to hospitalization or treatment at an Emergency Department (ED), Urgent Care (UC), or doctor’s office. Of these 69 complications, 45 were due to infection (1.74%). Thirty serious complications in total led to hospitalization (1.16%), 14 (0.54%) were treated at the ED, 1 was managed at an UC (0.04%) and 24 (0.93%) were treated at the doctor’s office. Of the 2,410 mailed patient questionnaires 847 (35.3%) were returned and were considered appropriate for analysis. Nine patients (1.06%) were hospitalized within 30 days of the procedure while 27 were treated in the outpatient setting (3.19%), 8 (0.94%) at the ED, 2(0.24%) at a UC, and 16 (1.89%) in the doctor’s office. Of the 9 patient-reported hospitalizations, 7 (77.8%) were detected by the electronic EMR query.  One thousand and twenty seven patients (39.7%) were under 65 years old and 1,561 (60.3%) were over 65 years old at the time of biopsy.

Conclusions

Our dual analysis study indicates a slightly greater than 1% incidence of hospitalization due to serious complications following PNB. These findings differ significantly from prior administrative claims based reports questioning their accuracy and reliability.  In comparison to the patient questionnaire study, the EMR querying software detected almost 80% of these patient reported hospitalizations. Serious PNB associated complications appear to be more frequently managed outside the hospital setting (ED, UC, and doctor’s office).  These results demonstrate how data rich EMRs provide opportunities for data retrieval, medical evaluation and reporting of clinical outcomes.   The significant number of patients under 65 years of age, almost 40%, highlights potential limitations of SEER Administrative claims based studies.