World journal of urology · 2025
Contemporary rates and predictors of prolonged hospital stay after radical cystectomy: a population-based analysis.
СтатьяНазвание и аннотация: Перевод в очереди
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Rodriguez Peñaranda Natali, Falkenbach Fabian, Marmiroli Andrea, Longoni Mattia, Le Quynh Chi, Catanzaro Calogero, Nicolazzini Michele, Di Bello Francesco, Goyal Jordan A, Saad Fred, Shariat Shahrokh F, Musi Gennaro, Graefen Markus, Briganti Alberto, Chun Felix K H, Schiavina Riccardo, Volpe Alessandro, Resca Stefano, Tavolini Ivan Matteo, Puliatti Stefano, Micali Salvatore, Karakiewicz Pierre I
Аннотация
OBJECTIVE: To test contemporary rates and predictors of prolonged hospital stay after radical cystectomy (RC) and ileal conduit in non-metastatic bladder cancer patients.
METHODS: Within the National Inpatient Sample database (NIS, 2008-2019), we identified ileal conduit RC patients and tabulated length of stay (LOS) ≥ 75th percentile vs. others. Temporal trends and multivariable logistic regression models (LRM) were fitted.
RESULTS: Of 10,934 patients, 3,116 (28%) exhibited LOS ≥ 75th percentile (≥ 10 days), with rates decreasing from 35.4% in 2008 to 20.0% in 2019 (p < 0.001). In multivariable LRM, independent predictors of LOS ≥ 75th percentile were age ≥ 80 years (OR 1.37), CCI ≥ 2 (OR 1.55), coagulopathy (OR 1.55), obesity (OR 1.15), African American race/ethnicity (OR 1.57), female sex (OR 1.17), Medicare (OR 1.24) or Medicaid (OR 1.41) insurance, and treatment at low- (OR 1.68) or medium-volume hospitals (OR 1.33). Conversely, minimally invasive surgery (OR 0.59) exhibited the opposite protective effect (all p ≤ 0.03). Interestingly, the combined effect of age (≥ 80 vs. < 80 years) and surgical approach (minimally invasive vs. open) also achieved independent predictive status. Specifically, patients aged ≥ 80 undergoing minimally invasive, < 80 undergoing open, and ≥ 80 undergoing open surgery were, respectively, 1.35, 1.65, and 2.29 times more likely to require LOS ≥ 75th percentile compared to those aged < 80 undergoing minimally invasive surgery (all p ≤ 0.004).
CONCLUSION: The proportion requiring LOS ≥ 75th percentile decreased over time. Multivariable LRMs showed that age, race, insurance, hospital characteristics, and surgical approach were significantly associated with LOS ≥ 75th percentile. Combinations of variables, such as age ≥ 80 and open surgery, identified higher-risk subgroups.
METHODS: Within the National Inpatient Sample database (NIS, 2008-2019), we identified ileal conduit RC patients and tabulated length of stay (LOS) ≥ 75th percentile vs. others. Temporal trends and multivariable logistic regression models (LRM) were fitted.
RESULTS: Of 10,934 patients, 3,116 (28%) exhibited LOS ≥ 75th percentile (≥ 10 days), with rates decreasing from 35.4% in 2008 to 20.0% in 2019 (p < 0.001). In multivariable LRM, independent predictors of LOS ≥ 75th percentile were age ≥ 80 years (OR 1.37), CCI ≥ 2 (OR 1.55), coagulopathy (OR 1.55), obesity (OR 1.15), African American race/ethnicity (OR 1.57), female sex (OR 1.17), Medicare (OR 1.24) or Medicaid (OR 1.41) insurance, and treatment at low- (OR 1.68) or medium-volume hospitals (OR 1.33). Conversely, minimally invasive surgery (OR 0.59) exhibited the opposite protective effect (all p ≤ 0.03). Interestingly, the combined effect of age (≥ 80 vs. < 80 years) and surgical approach (minimally invasive vs. open) also achieved independent predictive status. Specifically, patients aged ≥ 80 undergoing minimally invasive, < 80 undergoing open, and ≥ 80 undergoing open surgery were, respectively, 1.35, 1.65, and 2.29 times more likely to require LOS ≥ 75th percentile compared to those aged < 80 undergoing minimally invasive surgery (all p ≤ 0.004).
CONCLUSION: The proportion requiring LOS ≥ 75th percentile decreased over time. Multivariable LRMs showed that age, race, insurance, hospital characteristics, and surgical approach were significantly associated with LOS ≥ 75th percentile. Combinations of variables, such as age ≥ 80 and open surgery, identified higher-risk subgroups.