Surgical and postoperative factors affecting length of hospital stay afterradical prostatectomy

BACKGROUND. Radical prostatectomy continues to comprise the mainstay of the rapy for localized prostate carcinoma. However, caring for radical prostate ctomy patients accounts for approximately half of the $1.7 billion annual c ost of prostate carcinoma treatment. Length of stay (LOS) after surgery app ears to be one of the main components of this cost. The first step in reduc ing cost is to identify those variables associated with LOS. Radical prosta tectomy can be performed using two very different surgical techniques and w ith each technique different costs are incurred. The objective of the curre nt study was to identify factors associated with LOS as a function of surgi cal approach. To reduce potential biases due to patient requests for longer hospitalization or physician preferences in that regard, secondary objecti ves were to identify factors associated with time to fluid intake (TTF) and time to consume solid foods (TTS). METHODS, hn institutional-based, retrospective chart review of 313 men with clinically localized prostate carcinoma who underwent either a perineal (R PP) or retropubic [RRF) prostatectomy at a single university center from Ma rch 1988 to October 1996 was undertaken. Information regarding LOS was avai lable fur 311 patients. Linear regression models were used to assess the as sociation between covariables and LOS. Poisson regression models for count data were used to assess associations between covariables and the secondary endpoints of TTF and TTS. Covariables included: preoperative (age, race, p rostate specific antigen, Gleason score, clinical stage, lymph node resecti on, comorbidity, and admission time), intraoperative (surgical approach, su rgeon, operative time, estimated blood loss, transfusion requirement, anest hetic approach, and American Society of Anesthesiologists score), and posto perative (pain management complications and transfusions) parameters. RESULTS. The median LOS was 4 days (range, 1-19 days) for RPP and 5 days (r ange, 3-16 days) for RRP approaches. The final model included six main effe cts and three interaction terms. Overall, LOS decreased over time with LOS decreasing at a faster rate in patients who underwent RPP. In general, pati ents who underwent RRP had an increased LOS compared with patients who unde rwent RPP. Complications from surgery and age increased the LOS for all pat ients; however, the increase was greater in patients who underwent RPP. In addition, the use of intraoperative epidural anesthesia and the increased u se of postoperative narcotics were associated with increased LOS for patien ts undergoing both surgical approaches. TTF and TTS were significantly long er for patients who underwent the retropubic approach compared with those p atients who underwent the perineal approach. After adjustment for surgical approach no other covariables were found to be associated with TTF. After a djustment for surgical approach, the occurrence of complications was found to be associated with TTS, indicating that patients who experienced complic ations took longer before they could tolerate solid foods. CONCLUSIONS, In view of the importance of clinical care pathways in reducin g medical expenditures from radical prostatectomy, the results of the curre nt study may contribute to the further refining of these pathways by highli ghting the differences and similarities among the variables affecting LOS a s a function of surgical approach. (C) 2000 American Cancer Society.