Factors predicting hospital length-of-stay after radical prostatectomy: a population-based study

Abstract

BackgroundRadical prostatectomy (RP) is a leading treatment option for localised prostate cancer. Although hospital in-patient stays accounts for much of the costs of treatment, little is known about population-level trends in length-of-stay (LOS). We investigated factors predicting hospital LOS and readmissions in men who had RP following prostate cancer.MethodsIncident prostate cancers (ICD-O3: C61), diagnosed January 2002-December 2008 in men < 70 years, were identified from the Irish Cancer Registry, and linked to public hospital episodes. For those who had RP (ICD-9 CM procedure codes 60.3, 60.4, 60.5, 60.62) the associated hospital episode was identified. LOS was calculated as the number of days from date of admission to date of discharge. Patient-, tumour-, and health service-related factors predicting longer LOS (upper quartile, >9 days) were investigated using logistic regression. Patterns in day-case and in-patient readmissions within 28 days of discharge following RP were explored.ResultsOver the study period 9096 prostate cancers were diagnosed in men under 70, 26.5% of whom had RP by end of follow-up 31/12/2009. Two of eight public hospitals and eight of forty surgeons carried out 50% of all public-service RPs. Median LOS was 8 days (10th-90th percentile = 6-13 days) and fell significantly over time (2002, 9 days; 2008, 7 days; p < 0.001). In adjusted analyses men who were not married (OR = 1.71, 95% CI 1.25-2.34), had co-morbidities (OR = 1.64, 95% CI 1.25-2.16) or stage III-IV cancer (OR = 2.19, 95% CI 1.44-3.34) were significantly more likely to have prolonged LOS. Those treated in higher volume hospitals (annual median >49 RPs) or by higher volume surgeons (annual median >17 RPs) were significantly less likely to have prolonged LOS (OR = 0.34, 95% CI 0.26-0.45; OR = 0.55, 95% CI 0.42-0.71 respectively).ConclusionMedian LOS after RP decreased between 2002 and 2008 in Ireland but it remains higher than in both England and the US. Although volumes of RPs conducted in Ireland are low, there is considerable variation between hospitals and surgeons. Hospital and surgeon volume were strong predictors of shorter LOS, after adjusting for other variables. These factors point to a need for a comprehensive review of prostate cancer service provision.

Impact of patient choice and hospital competition on patient outcomes after prostate cancer surgery: A national population‐based study

“…This explains why adding the mean annual procedure volume and the prostatectomy type separately to the regression model weakened the association between being a successful competitor and length of stay. This is in line with the existing evidence that robotic‐assisted RP and procedure volume are associated with reduced lengths of stay …”

“…This is in line with the existing evidence that robotic-assisted RP and procedure volume are associated with reduced lengths of stay. [31][32][33] Neither RP procedure type nor procedure volume was included in the original regression model, because both of these factors are potentially in the causal pathway explaining why hospitals classified as more successful competitors may demonstrate superior patient-level outcomes. Furthermore, there is a long-standing debate about the direction of effect with respect to the volume-outcome correlation.…”

High lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of re-admission and death: National cohort analysis in England

“…The results for length of stay and re-admission emphasise that other relevant outcomes vary along the gradient from low hospital volume (and high mortality) to high volume (and lower mortality). A number of recent studies have explored associations within the wider set of outcomes: hospital volume, length of stay, complications, re-admission, mortality, and cost (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). None of these papers addresses all of the possible associations, but the emerging pattern is one of correlated and consistently favourable outcomes in high-volume hospitals.…”

Nursing diagnoses and NIC interventions in adult males undergoing radical prostatectomy

“…Data collection was carried out by physical assessment, examination of patients' records, observation, and face-to--face interview with patients. The follow-up period was four days after the surgery, determined based on a laparoscopic RP operation and the 2-4 day discharge period stated in the literature (4,16) .…”

“…A data collection form in line with a comprehensive review of literature was prepared by researchers. The form consisted of Gordon's Functional Health Patterns (FHP), sociodemographic features and postoperative assessments of patients (4)(5)10,(16)(17) . The FHP method was developed by Marjory Gordon (18) and is used by nurses in the nursing process for a comprehensive nursing assessment of patients.…”