Cost of Care in Open Cystectomy Patients Across Time and Space: Does It Matter?

Overview

Journal Bladder Cancer

Publisher IOS Press

Date 2024 Jul 12

PMID 38993992

Authors

Helen H Sun

Megan Prunty

Ilaha Isali

Amr Mahran

Kevin Ginsburg

Sarah Markt

Lee Ponsky

Adam Calaway

Laura Bukavina

Affiliations

Soon will be listed here.

Abstract

Background: Many variables may affect the cost of open radical cystectomy (RC) care, including surgical approach, diversion type, patient comorbidities, and postoperative complications.

Objective: To determine factors associated with changes in cost of care following open radical cystectomy (ORC) for bladder cancer using the National Inpatient Sample (NIS).

Methods: Patients in the NIS with a diagnosis of bladder cancer who underwent ORC with ileal conduit from 2012-2017 using ICD-9-CM and ICD-10-CM codes were identified. Baseline demographics including age, race, region, postoperative complications, and length of stay were obtained. Univariable and multivariable logistic regression were used to identify factors associated with cost variation including demographics, clinical characteristics, surgical factors, and discharge quarter (Q1-Q4).

Results: 5,189 patients were included in the analysis, with 4,379 at urban teaching hospitals. On multivariable regression analysis, female sex [$1,734 ($1,024-2,444) < 0.001)], a greater Elixhauser comorbidity score [$93 ($62-124), < 0.001], presence of any inpatient complication [$1,531 ($894-2,168), < 0.001], and greater length of stay [$1,665 ($1,536-1,793), < 0.001] were associated with a greater cost of hospitalization. Discharge in Q3 (July to September) relative to Q2 (April to June) was associated with a higher cost [$1,113 ($292-1,933), = 0.008. Trends were similar at urban non-teaching and rural hospitals, except discharge quarter was not associated with a significant change in cost.

Conclusions: Significant differences in cost of ORC with ileal conduit exist with respect to patient sex, medical comorbidities, and discharge timing. These differences may relate to greater disease burden in female patients, patient complexity, and variation in postoperative care in academic programs.

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