Abstract
We sought to examine the impact of baseline patient characteristics and perioperative outcomes on postoperative hospital length of stay (LOS), following the robot-assisted radical prostatectomy (RARP). We retrospectively reviewed consecutive patients receiving RARP at our institution by two surgeons between January 2012 and March 2014 (n = 274). Baseline patient characteristics were collected, including Charlson comorbidity index (CCI). Discharge criteria were identical for all patients and included: return of bowel function, pain controlled with oral medications, and ambulation without assistance. LOS was calculated as the number of midnights spent in the hospital following surgery. Postoperative hospital LOS was equal to 1 day for 225 patients and >1 day for 49 patients. Baseline patient and tumor characteristics, including age, race, body-mass index (BMI), pathologic stage, and Gleason score, were not significantly different. Mean operative time was shorter for patients with LOS > 1 day (155 vs. 173 min, p < 0.01) on univariate analysis. Patients with LOS > 1 day were more likely to have had a complication: 8/49 (17 %) vs. 14/225 (6 %), p < 0.01. However, multivariate logistic regression found baseline CCI > 2 as the only independent predictor of LOS > 1 day (OR = 3.2, p = 0.03), controlling for age, race, BMI, Gleason score, tumor stage, blood loss, operative time, and occurrence of complication. In our experience, baseline patient comorbidity, quantified by CCI, was the only independent predictor of hospital LOS greater than 1 day following RARP. Preoperative assessment of patient comorbidity should be used to better counsel patients on their anticipated postoperative course.
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Stitzenberg KB, Wong YN, Nielsen ME, Egleston BL, Uzzo RG (2012) Trends in radical prostatectomy: centralization, robotics, and access to urologic cancer care. Cancer 118(1):54–62. doi:10.1002/cncr.26274
Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P (2012) 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 62(1):1–15. doi:10.1016/j.eururo.2012.02.029
Alemozaffar M, Sanda M, Yecies D, Mucci LA, Stampfer MJ, Kenfield SA (2014) Benchmarks for operative outcomes of robotic and open radical prostatectomy: results from the health professionals follow-up study. Eur Urol. doi:10.1016/j.eururo.2014.01.039
Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, Gingrich JR, Wei JT, Gilhooly P, Grob BM, Nsouli I, Iyer P, Cartagena R, Snider G, Roehrborn C, Sharifi R, Blank W, Pandya P, Andriole GL, Culkin D, Wheeler T, Prostate Cancer Intervention versus Observation Trial Study G (2012) Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 367(3):203–213. doi:10.1056/NEJMoa1113162
Bill-Axelson A, Holmberg L, Ruutu M, Garmo H, Stark JR, Busch C, Nordling S, Haggman M, Andersson SO, Bratell S, Spangberg A, Palmgren J, Steineck G, Adami HO, Johansson JE, Investigators S- (2011) Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 364(18):1708–1717. doi:10.1056/NEJMoa1011967
Polverejan E, Gardiner JC, Bradley CJ, Holmes-Rovner M, Rovner D (2003) Estimating mean hospital cost as a function of length of stay and patient characteristics. Health Econ 12(11):935–947. doi:10.1002/hec.774
Thomas JW, Guire KE, Horvat GG (1997) Is patient length of stay related to quality of care? Hosp Health Serv Adm 42(4):489–507
Spencer BA, Steinberg M, Malin J, Adams J, Litwin MS (2003) Quality-of-care indicators for early-stage prostate cancer. J Clin Oncol Off J Am Soc Clin Oncol 21(10):1928–1936. doi:10.1200/JCO.2003.05.157
Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, Menon M, Montorsi F, Patel VR, Stolzenburg JU, Van der Poel H, Wilson TG, Zattoni F, Mottrie A (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62(3):405–417. doi:10.1016/j.eururo.2012.05.045
Novara G, Ficarra V, Rosen RC, Artibani W, Costello A, Eastham JA, Graefen M, Guazzoni G, Shariat SF, Stolzenburg JU, Van Poppel H, Zattoni F, Montorsi F, Mottrie A, Wilson TG (2012) Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 62(3):431–452. doi:10.1016/j.eururo.2012.05.044
Ficarra V, Novara G, Ahlering TE, Costello A, Eastham JA, Graefen M, Guazzoni G, Menon M, Mottrie A, Patel VR, Van der Poel H, Rosen RC, Tewari AK, Wilson TG, Zattoni F, Montorsi F (2012) Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol 62(3):418–430. doi:10.1016/j.eururo.2012.05.046
Liu JJ, Maxwell BG, Panousis P, Chung BI (2013) Perioperative outcomes for laparoscopic and robotic compared with open prostatectomy using the National Surgical Quality Improvement Program (NSQIP) database. Urology 82(3):579–583. doi:10.1016/j.urology.2013.03.080
Trinh QD, Sammon J, Sun M, Ravi P, Ghani KR, Bianchi M, Jeong W, Shariat SF, Hansen J, Schmitges J, Jeldres C, Rogers CG, Peabody JO, Montorsi F, Menon M, Karakiewicz PI (2012) Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol 61(4):679–685. doi:10.1016/j.eururo.2011.12.027
Novara G, Ficarra V, Mocellin S, Ahlering TE, Carroll PR, Graefen M, Guazzoni G, Menon M, Patel VR, Shariat SF, Tewari AK, Van Poppel H, Zattoni F, Montorsi F, Mottrie A, Rosen RC, Wilson TG (2012) Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 62(3):382–404. doi:10.1016/j.eururo.2012.05.047
Hu JC, Gandaglia G, Karakiewicz PI, Nguyen PL, Trinh QD, Shih YC, Abdollah F, Chamie K, Wright JL, Ganz PA, Sun M (2014) Comparative effectiveness of robot-assisted versus open radical prostatectomy cancer control. Eur Urol 66(4):666–672. doi:10.1016/j.eururo.2014.02.015
Barocas DA, Mitchell R, Chang SS, Cookson MS (2010) Impact of surgeon and hospital volume on outcomes of radical prostatectomy. Urol Oncol 28(3):243–250. doi:10.1016/j.urolonc.2009.03.001
Trinh QD, Schmitges J, Sun M, Shariat SF, Sukumar S, Bianchi M, Tian Z, Jeldres C, Sammon J, Perrotte P, Graefen M, Peabody JO, Menon M, Karakiewicz PI (2011) Radical prostatectomy at academic versus nonacademic institutions: a population based analysis. J Urol 186(5):1849–1854. doi:10.1016/j.juro.2011.06.068
Monn MF, Jain R, Kaimakliotis HZ, Flack CK, Koch MO, Boris RS (2014) Examining the relationship between operative time and hospitalization time in minimally invasive and open urologic procedures. J Endourol/Endourol Soc 28(9):1132–1137. doi:10.1089/end.2014.0259
Huang KH, Kaplan AL, Carter SC, Lipsitz SR, Hu JC (2014) The impact of radical prostatectomy operative time on outcomes and costs. Urology 83(6):1265–1271. doi:10.1016/j.urology.2014.01.047
Procter LD, Davenport DL, Bernard AC, Zwischenberger JB (2010) General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 210(1):60–65 e61–62. doi:10.1016/j.jamcollsurg.2009.09.034
Bolenz C, Gupta A, Hotze T, Ho R, Cadeddu JA, Roehrborn CG, Lotan Y (2010) Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. Eur Urol 57(3):453–458. doi:10.1016/j.eururo.2009.11.008
Scales CD Jr, Jones PJ, Eisenstein EL, Preminger GM, Albala DM (2005) Local cost structures and the economics of robot assisted radical prostatectomy. J Urol 174(6):2323–2329. doi:10.1097/01.ju.0000181830.43340.e7
Bolenz C, Gupta A, Roehrborn CG, Lotan Y (2011) Predictors of costs for robotic-assisted laparoscopic radical prostatectomy. Urol Oncol 29(3):325–329. doi:10.1016/j.urolonc.2011.01.016
Epstein AM (2009) Revisiting readmissions–changing the incentives for shared accountability. N Engl J Med 360(14):1457–1459. doi:10.1056/NEJMe0901006
Jacobs BL, Zhang Y, Tan HJ, Ye Z, Skolarus TA, Hollenbeck BK (2013) Hospitalization trends after prostate and bladder surgery: implications of potential payment reforms. J Urol 189(1):59–65. doi:10.1016/j.juro.2012.08.182
Specifications Manual for National Hospital Inpatient Quality Measures (2014). http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx. Accessed 3 Feb 2015
Tess BH, Glenister HM, Rodrigues LC, Wagner MB (1993) Incidence of hospital-acquired infection and length of hospital stay. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol 12(2):81–86
Leonhardt D (2009) In health reform, a cancer offers and acid test. http://www.nytimes.com/2009/07/08/business/economy/08leonhardt.html?_r=0. Accessed 27 Jan 2015
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Aaron Potretzke, Eric Kim, Brent Knight, Barrett Anderson, Alyssa Park, Robert Figenshau, and Sam Bhayani declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
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Potretzke, A.M., Kim, E.H., Knight, B.A. et al. Patient comorbidity predicts hospital length of stay after robot-assisted prostatectomy. J Robotic Surg 10, 151–156 (2016). https://doi.org/10.1007/s11701-016-0588-6
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DOI: https://doi.org/10.1007/s11701-016-0588-6