Pre- and Intra-operative Predictors of Postoperative Hospital Length of Stay in Patients Undergoing Radical Prostatectomy for Prostate Cancer in China: a Retrospective Observational Study

Overview

Journal BMC Urol

Publisher Biomed Central

Specialty Urology

Date 2018 May 20

PMID 29776408

Citations 4

Authors

Qingmei Huang

Ping Jiang

Lina Feng

Liping Xie

Shuo Wang

Dan Xia

Baihua Shen

Baiye Jin

Li Zheng

Wei Wang

Affiliations

Soon will be listed here.

Abstract

Background: Hospital length of stay (LOS) has recently been receiving increasing attention as a marker of medical resource consumption. Identifying predictors of longer LOS can better equip doctors to counsel patients and facilitate more efficient patient flow and utilization of medical resources. The objective of this study was to identify pre- and intra-operative risk factors for postoperative hospital LOS in patients who had undergone radical prostatectomy in China.

Methods: We retrospectively analyzed data of 793 eligible patients with prostate cancer who had undergone radical prostatectomy in our institution between January 2011 and March 2016. Relevant preoperative variables, including patient characteristics, medical comorbidities, prostate cancer disease-specific variables, urinary tract symptoms, preoperative laboratory values, and intraoperative variables including operation type, operation duration, and blood loss, were analyzed. The outcome was postoperative length of stay which was calculated as the time from the date of operation to the date of discharge. Multiple linear regression analysis was used to identify predictors of this outcome.

Results: The mean postoperative LOS was 11.7 days (±4.6 days) and the median 10 days (range, 5-46 days). According to univariate and multivariate analysis, operation type (open or laparoscopic), blood loss, Gleason score (≥8) and preoperative laboratory values of white blood count (WBC) were found to be the main explanatory predictors of postoperative LOS of patients with prostate cancer in our institution. Additionally, open surgery was the strongest significant predictor of longer LOS according to the standardized coefficients in this model.

Conclusions: Our findings indicate that significant predictors of longer postoperative LOS in patients who have undergone radical prostatectomy in China include both preoperative variables of Gleason score, WBC and intraoperative variables of operation type (open or laparoscopic), blood loss. To shorten hospital LOS in patients with prostate cancer and optimize utilization of Chinese medical resources, efforts should be made to improve the intraoperative process and reduce the prevalence of preoperative risk factors.

Citing Articles

Effect of Early Postoperative Rehabilitation on Length of Hospital Stay after Robot-assisted Radical Prostatectomy.

Higuchi S, Matsugaki R, Tomisaki I, Fushimi K, Matsuda S, Saeki S Prog Rehabil Med. 2023; 8:20230023.

PMID: 37534203 PMC: 10391540. DOI: 10.2490/prm.20230023.

Postoperative Effect Observation and Clinical Study of Dahuang Zhechong Pills from in Treating Patients with Early-to-Mid Prostate Cancer Undergoing Radical Resection.

Hou S, Bin C Comput Intell Neurosci. 2022; 2022:2998825.

PMID: 35528360 PMC: 9068324. DOI: 10.1155/2022/2998825.

Patient characteristics predicting prolonged length of hospital stay following robotic-assisted radical prostatectomy.

Hajj A, Labban M, Ploussard G, Zarka J, Heidar N, Mailhac A Ther Adv Urol. 2022; 14:17562872221080737.

PMID: 35321053 PMC: 8935550. DOI: 10.1177/17562872221080737.

The role of body mass index on quality indicators following minimally-invasive radical prostatectomy.

Pathak R, Wilson R, Craven T, Matz E, Hemal A Investig Clin Urol. 2021; 62(3):290-297.

PMID: 33834640 PMC: 8100006. DOI: 10.4111/icu.20200411.

References

Liu J, Maxwell B, Panousis P, Chung B . Perioperative outcomes for laparoscopic and robotic compared with open prostatectomy using the National Surgical Quality Improvement Program (NSQIP) database. Urology. 2013; 82(3):579-83. DOI: 10.1016/j.urology.2013.03.080. View

. Ending violence against doctors in China. Lancet. 2012; 379(9828):1764. DOI: 10.1016/S0140-6736(12)60729-6. View

Procter L, Davenport D, Bernard A, Zwischenberger J . General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg. 2010; 210(1):60-5.e1-2. DOI: 10.1016/j.jamcollsurg.2009.09.034. View

Monn M, Jain R, Kaimakliotis H, Flack C, Koch M, Boris R . Examining the relationship between operative time and hospitalization time in minimally invasive and open urologic procedures. J Endourol. 2014; 28(9):1132-7. DOI: 10.1089/end.2014.0259. View

Ye D, Zhu Y . [Epidemiology of prostate cancer in China: an overview and clinical implication]. Zhonghua Wai Ke Za Zhi. 2015; 53(4):249-52. View

Alemozaffar M, Sanda M, Yecies D, Mucci L, Stampfer M, Kenfield S . Benchmarks for operative outcomes of robotic and open radical prostatectomy: results from the Health Professionals Follow-up Study. Eur Urol. 2014; 67(3):432-8. PMC: 4128909. DOI: 10.1016/j.eururo.2014.01.039. View

Huang X, Wang L, Zheng X, Wang X . Comparison of perioperative, functional, and oncologic outcomes between standard laparoscopic and robotic-assisted radical prostatectomy: a systemic review and meta-analysis. Surg Endosc. 2016; 31(3):1045-1060. DOI: 10.1007/s00464-016-5125-1. View

Bolenz C, Gupta A, Roehrborn C, Lotan Y . Predictors of costs for robotic-assisted laparoscopic radical prostatectomy. Urol Oncol. 2011; 29(3):325-9. DOI: 10.1016/j.urolonc.2011.01.016. View

Jingang A . Which future for doctors in China?. Lancet. 2013; 382(9896):936-7. DOI: 10.1016/S0140-6736(13)61928-5. View

10.

Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J . Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010; (3):CD006632. DOI: 10.1002/14651858.CD006632.pub2. View

11.

Trinh Q, Sammon J, Sun M, Ravi P, Ghani K, Bianchi M . Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol. 2011; 61(4):679-85. DOI: 10.1016/j.eururo.2011.12.027. View

12.

Tewari A, Sooriakumaran P, Bloch D, Seshadri-Kreaden U, Hebert A, Wiklund P . Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol. 2012; 62(1):1-15. DOI: 10.1016/j.eururo.2012.02.029. View

13.

Li Q, Lin Z, Masoudi F, Li J, Li X, Hernandez-Diaz S . National trends in hospital length of stay for acute myocardial infarction in China. BMC Cardiovasc Disord. 2015; 15:9. PMC: 4360951. DOI: 10.1186/1471-2261-15-9. View

14.

Polverejan E, Gardiner J, Bradley C, Holmes-Rovner M, Rovner D . Estimating mean hospital cost as a function of length of stay and patient characteristics. Health Econ. 2003; 12(11):935-47. DOI: 10.1002/hec.774. View

15.

Basto M, Sathianathen N, Te Marvelde L, Ryan S, Goad J, Lawrentschuk N . Patterns-of-care and health economic analysis of robot-assisted radical prostatectomy in the Australian public health system. BJU Int. 2015; 117(6):930-9. DOI: 10.1111/bju.13317. View

16.

Glance L, Stone P, Mukamel D, Dick A . Increases in mortality, length of stay, and cost associated with hospital-acquired infections in trauma patients. Arch Surg. 2011; 146(7):794-801. PMC: 3336161. DOI: 10.1001/archsurg.2011.41. View

17.

Potretzke A, Kim E, Knight B, Anderson B, Park A, Figenshau R . Patient comorbidity predicts hospital length of stay after robot-assisted prostatectomy. J Robot Surg. 2016; 10(2):151-6. DOI: 10.1007/s11701-016-0588-6. View

18.

Felder S . The variance of length of stay and the optimal DRG outlier payments. Int J Health Care Finance Econ. 2008; 9(3):279-89. DOI: 10.1007/s10754-008-9051-1. View

19.

Zhang L, Cheng X, Liu X, Zhu K, Tang S, Bogg L . Balancing the funds in the New Cooperative Medical Scheme in rural China: determinants and influencing factors in two provinces. Int J Health Plann Manage. 2009; 25(2):96-118. DOI: 10.1002/hpm.988. View

20.

Resnick M, Lacchetti C, Bergman J, Hauke R, Hoffman K, Kungel T . Prostate cancer survivorship care guideline: American Society of Clinical Oncology Clinical Practice Guideline endorsement. J Clin Oncol. 2015; 33(9):1078-85. DOI: 10.1200/JCO.2014.60.2557. View