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Prolonged Length of Stay After Robotic Prostatectomy: Causes and Risk Factors

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Robot-assisted radical prostatectomy (RARP) can generally be performed with 1–2 nights of postoperative monitoring before discharge from the hospital. Little is known about what causes individual patients to remain in hospital beyond the second postoperative day.

Methods

Data for RARPs performed between 2013 and 2015 were extracted from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The fraction of cases with prolonged length of stay (PLOS) that can be reasonably attributed to complications was examined. Logistic regression was performed to identify risk factors for PLOS in the overall population and separately in the population of patients with PLOS without any perioperative complications.

Results

Of 11,440 patients, 10,342 (90.4%) were discharged on postoperative days 0–2; 80.6% (887/1101) of patients with PLOS did not experience any perioperative complications. The most common complication was bleeding requiring transfusion, but this was present in only 5.6% (62/1101) of patients with PLOS. Logistic regression identified predictors of PLOS as age, race, wound class, American Society of Anesthesiologists class, smoking, diabetes, dyspnea, dependent functional health status, congestive heart failure, operative time, and pelvic lymph node dissection. Results of this regression were insensitive to the exclusion of patients who experienced no perioperative complications.

Conclusions

This study utilizes logistic regression on NSQIP data to identify risk factors for PLOS after RARP and, in particular, to evaluate the role of postoperative complications in PLOS. The analysis shows that postoperative complications account for a small minority of cases of PLOS after RARP.

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References

  1. Halpern J, Shoag J, Artis A, Ballman K, Sedrakyan A, Hershman D, et al. National trends in prostate biopsy and radical prostatectomy volumes following the US preventive services task force guidelines against prostate-specific antigen screening. JAMA Surg. 2017;152(2):192. https://doi.org/10.1001/jamasurg.2016.3987

    Article  PubMed  Google Scholar 

  2. Leow J, Chang S, Meyer C, Wang Y, Hanske J, Sammon J, et al. Robot-assisted versus open radical prostatectomy: a contemporary analysis of an all-payer discharge database. Europ Urol. 2016;70:837–45. https://doi.org/10.1016/j.eururo.2016.01.044.

    Article  PubMed  Google Scholar 

  3. Nelson B, Kaufman M, Broughton G, et al. Comparison of length of hospital stay between radical retropubic prostatectomy and robotic assisted laparoscopic prostatectomy. J Urol. 2007;177(3):929–31. https://doi.org/10.1016/j.juro.2006.10.070.

    Article  PubMed  Google Scholar 

  4. Brasel KJ, Lim HJ, Nirula R, Weigelt JA. Length of stay: an appropriate quality measure? Arch Surg. 2007;142(5):461. https://doi.org/10.1001/archsurg.142.5.461.

    Article  PubMed  Google Scholar 

  5. Farjah F, Lou F, Rusch VW, Rizk NP. The quality metric prolonged length of stay misses clinically important adverse events. Ann Thorac Surg. 2012;94(3):881–88. https://doi.org/10.1016/j.athoracsur.2012.04.082.

    Article  PubMed  Google Scholar 

  6. Zehr KJ, Dawson PB, Yang SC, Heitmiller RF. Standardized clinical care pathways for major thoracic cases reduce hospital costs. Ann Thorac Surg. 1998;66(3):914–19.

    Article  CAS  Google Scholar 

  7. Trinh Q-D, Bianchi M, Sun M, et al. Discharge patterns after radical prostatectomy in the United States of America. Urol Oncol Semin Orig Investig. 2013;31(7):1022–32. https://doi.org/10.1016/j.urolonc.2011.10.007.

    Article  Google Scholar 

  8. Yao S-L, Lu-Yao G. Population-based study of relationships between hospital volume of prostatectomies, patient outcomes, and length of hospital stay. JNCI J Natl Cancer Inst. 1999;91(22):1950–56. https://doi.org/10.1093/jnci/91.22.1950.

    Article  CAS  PubMed  Google Scholar 

  9. Gore JL, Wright JL, Daratha KB, et al. Hospital-level variation in the quality of urologic cancer surgery. Cancer. 2012;118(4):987–96. https://doi.org/10.1002/cncr.26373.

    Article  PubMed  Google Scholar 

  10. Fuchshuber PR, Greif W, Tidwell CR, et al. The power of the National Surgical Quality Improvement Program: achieving a zero pneumonia rate in general surgery patients. Perm J. 2012;16(1):39–45.

    Article  Google Scholar 

  11. Alluri RK, Leland H, Heckmann N. Surgical research using national databases. Ann Transl Med. 2016;4(20):393. https://doi.org/10.21037/atm.2016.10.49.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pilecki MA, McGuire BB, Jain U, Kim JYS, Nadler RB. National multi-institutional comparison of 30-day postoperative complication and readmission rates between open retropubic radical prostatectomy and robot-assisted laparoscopic prostatectomy using NSQIP. J Endourol. 2014;28(4):430–6. https://doi.org/10.1089/end.2013.0656.

    Article  PubMed  Google Scholar 

  13. Bateni SB, Meyers FJ, Bold RJ, Canter RJ. Increased rates of prolonged length of stay, readmissions, and discharge to care facilities among postoperative patients with disseminated malignancy: implications for clinical practice. PLoS One. 2016;11(10):e0165315. https://doi.org/10.1371/journal.pone.0165315.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Collins TC, Daley J, Henderson WH, Khuri SF. Risk factors for prolonged length of stay after major elective surgery. Ann Surg. 1999;230(2):251–9.

    Article  CAS  Google Scholar 

  15. Wallner LP, Dunn RL, Sarma AV, Campbell DA, Wei JT. Risk factors for prolonged length of stay after urologic surgery: the national surgical quality improvement program. J Am Coll Surg. 2008;207(6):904–13. https://doi.org/10.1016/j.jamcollsurg.2008.08.015.

    Article  PubMed  Google Scholar 

  16. User Guide for the 2014 ACS NSQIP Participant Use Data File (PUF). 2015. https://www.facs.org/~/media/files/quality programs/nsqip/nsqip_puf_userguide_2014.ashx. Accessed 20 Feb 2017.

  17. Sheils CR, Dahlke AR, Kreutzer L, Bilimoria KY, Yang AD. Evaluation of hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. Surgery. 2016;160(5):1182–8. https://doi.org/10.1016/j.surg.2016.04.034.

    Article  PubMed  Google Scholar 

  18. Krell RW, Girotti ME, Dimick JB. Extended Length of Stay After Surgery. JAMA Surg. 2014;149(8):815. https://doi.org/10.1001/jamasurg.2014.629.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Barocas DA, Mitchell R, Chang SS, Cookson MS. Impact of surgeon and hospital volume on outcomes of radical prostatectomy. Urol Oncol Semin Orig Investig. 2010;28(3):243–50. https://doi.org/10.1016/j.urolonc.2009.03.001.

    Article  Google Scholar 

  20. Rotter T, Kinsman L, James E, et al. The effects of clinical pathways on professional practice, patient outcomes, length of stay, and hospital costs. Eval Health Prof. 2012;35(1):3–27. https://doi.org/10.1177/0163278711407313.

    Article  PubMed  Google Scholar 

  21. Lau CSM, Chamberlain RS. Enhanced recovery after surgery programs improve patient outcomes and recovery: a meta-analysis. World J Surg. 2017;41(4):899–913. https://doi.org/10.1007/s00268-016-3807-4.

    Article  PubMed  Google Scholar 

  22. Wang EH, Yu JB, Gross CP et al. Variation in pelvic lymph node dissection among patients undergoing radical prostatetomy by hospital characteristics and surgical approach: results from the National Cancer Database. J Urol. 2015;193(3):820–5. https://doi.org/10.1016/j.juro.2014.09.019.

    Article  PubMed  Google Scholar 

  23. Kim MJ, Min GE, Yoo KH, Chang S-G, Jeon SH. Risk factors for postoperative ileus after urologic laparoscopic surgery. J Korean Surg Soc. 2011;80(6):384. https://doi.org/10.4174/jkss.2011.80.6.384.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Moghadamyeghaneh Z, Hwang GS, Hanna MH, et al. Risk factors for prolonged ileus following colon surgery. Surg Endosc. 2016;30(2):603–9. https://doi.org/10.1007/s00464-015-4247-1.

    Article  PubMed  Google Scholar 

  25. Offodile AC, Aherrera A, Guo L. Risk factors associated with prolonged postoperative stay following free tissue transfer: an analysis of 2425 patients from the American College of Surgeons National Surgical Quality Improvement Program database. Plast Reconstr Surg. 2014;134(6):1323–32. https://doi.org/10.1097/prs.0000000000000735.

    Article  CAS  PubMed  Google Scholar 

  26. Millan M, Biondo S, Fraccalvieri D, Frago R, Golda T, Kreisler E. Risk Factors for Prolonged postoperative ileus after colorectal cancer surgery. World J Surg. 2012;36(1):179–85. https://doi.org/10.1007/s00268-011-1339-5.

    Article  PubMed  Google Scholar 

  27. Artinyan A, Nunoo-Mensah JW, Balasubramaniam S, et al. Prolonged postoperative ileus-definition, risk factors, and predictors after surgery. World J Surg. 2008;32(7):1495–500. https://doi.org/10.1007/s00268-008-9491-2.

    Article  PubMed  Google Scholar 

  28. Ozdemir AT, Altinova S, Koyuncu H, Serefoglu EC, Cimen IH, Balbay DM. The incidence of postoperative ileus in patients who underwent robotic assisted radical prostatectomy. Cent Eur J Urol. 2014;67(1):19–24. https://doi.org/10.5173/ceju.2014.01.art4.

    Article  Google Scholar 

  29. Xia L, Taylor BL, Pulido JE, Mucksavage P, Lee DI, Guzzo TJ. Predischarge predictors of readmissions and postdischarge complications in robot-assisted radical prostatectomy. J Endourol. 2017;31(9):864–71. https://doi.org/10.1089/end.2017.0293.

    Article  PubMed  Google Scholar 

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Correspondence to Katharine F. Michel BA.

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Strother, M.C., Michel, K.F., Xia, L. et al. Prolonged Length of Stay After Robotic Prostatectomy: Causes and Risk Factors. Ann Surg Oncol 27, 1560–1567 (2020). https://doi.org/10.1245/s10434-020-08266-3

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  • DOI: https://doi.org/10.1245/s10434-020-08266-3

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