1766 LENGTH OF STAY FOLLOWING RADICAL CYSTECTOMY: HOW LONG IS LONG ENOUGH?

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive (III)1 Apr 20131766 LENGTH OF STAY FOLLOWING RADICAL CYSTECTOMY: HOW LONG IS LONG ENOUGH? Sapan Ambani, Alon Weizer, Jeffrey Montgomery, David Miller, Chang He, Stephen Dailey, Heather Crossley, Khaled Hafez, Brent Hollenbeck, Ted Skolarus, Cheryl Lee, James Montie, Ganesh Palapattu, and Todd Morgan Sapan AmbaniSapan Ambani Ann Arbor, MI More articles by this author , Alon WeizerAlon Weizer Ann Arbor, MI More articles by this author , Jeffrey MontgomeryJeffrey Montgomery Ann Arbor, MI More articles by this author , David MillerDavid Miller Ann Arbor, MI More articles by this author , Chang HeChang He Ann Arbor, MI More articles by this author , Stephen DaileyStephen Dailey Ann Arbor, MI More articles by this author , Heather CrossleyHeather Crossley Ann Arbor, MI More articles by this author , Khaled HafezKhaled Hafez Ann Arbor, MI More articles by this author , Brent HollenbeckBrent Hollenbeck Ann Arbor, MI More articles by this author , Ted SkolarusTed Skolarus Ann Arbor, MI More articles by this author , Cheryl LeeCheryl Lee Ann Arbor, MI More articles by this author , James MontieJames Montie Ann Arbor, MI More articles by this author , Ganesh PalapattuGanesh Palapattu Ann Arbor, MI More articles by this author , and Todd MorganTodd Morgan Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2895AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy (RC) for bladder cancer carries a high risk of early morbidity. While clinical pathways facilitating early discharge are increasingly utilized, it is unknown whether short length of stay (sLOS) may impact the likelihood of complication. We sought to determine whether sLOS is associated with complication risk following RC. METHODS The medical records of 829 consecutive patients undergoing RC for bladder cancer from 1/1/2005-7/15/2012 were reviewed. Patients were categorized by LOS as short (≤5 days), routine (6-9 days), or prolonged (≥10 days). Patients with prolonged LOS (n=323) were excluded, as these represent a distinct subset of patients with complicated admissions. Complications were classified by Clavien grade, and those occurring within 90 days of RC were analyzed as the primary outcome. Clinical and pathologic variables were compared using chi-squared tests, and univariable and multivariable logistic regression was performed to assess the relationship between LOS and complication risk. RESULTS There were 73/506 patients (14%) with sLOS compared to 433/506 patients (86%) classified as routine LOS in this cohort. Those with sLOS had a lower Charlson comorbidity index (p<0.001), less frequently received neoadjuvant chemotherapy (p<0.001), and more often underwent robotic RC (p=0.007). There were no significant differences in age, gender, ASA, BMI, race, diversion type, or pre-operative serum albumin according to LOS. Complications occurred more frequently in sLOS (31/73, 42.5%) vs. routine LOS (120/433, 27.7%) patients (OR 1.93, 95% CI 1.16-3.20). Additionally, major complications (≥acute; Clavien 3) occurred more frequently with sLOS (17.8% vs. 7.6%; OR 2.63, 95% CI 1.30-5.27). In the multivariable analysis (Table), sLOS was associated with a significant independent increase in the risk of 90-day morbidity compared to routine LOS (OR 1.84, 95% CI 1.03-3.29). CONCLUSIONS Early discharge post-RC appears to be associated with an increased risk of post-operative complications, suggesting that attempts to reduce LOS following RC could impact the likelihood of 90-day morbidity in these individuals. Further attention should be given to understanding whether a subset of patients may be safely discharged within 5 days of surgery or if a minimum LOS following RC should be established. Logistic regression for predictors of 90-day morbidity following radical cyste