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Factors predicting hospital length-of-stay after radical prostatectomy: a population-based study.

Kelly M, Sharp L, Dwane F, Kelleher T, Drummond FJ, Comber H - BMC Health Serv Res (2013)

Bottom Line: For those who had RP (ICD-9 CM procedure codes 60.3, 60.4, 60.5, 60.62) the associated hospital episode was identified.Median LOS was 8 days (10th-90th percentile = 6-13 days) and fell significantly over time (2002, 9 days; 2008, 7 days; p < 0.001).Median LOS after RP decreased between 2002 and 2008 in Ireland but it remains higher than in both England and the US.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Radical prostatectomy (RP) is a leading treatment option for localised prostate cancer. Although hospital in-patient stays accounts for much of the costs of treatment, little is known about population-level trends in length-of-stay (LOS). We investigated factors predicting hospital LOS and readmissions in men who had RP following prostate cancer.

Methods: Incident prostate cancers (ICD-O3: C61), diagnosed January 2002-December 2008 in men < 70 years, were identified from the Irish Cancer Registry, and linked to public hospital episodes. For those who had RP (ICD-9 CM procedure codes 60.3, 60.4, 60.5, 60.62) the associated hospital episode was identified. LOS was calculated as the number of days from date of admission to date of discharge. Patient-, tumour-, and health service-related factors predicting longer LOS (upper quartile, >9 days) were investigated using logistic regression. Patterns in day-case and in-patient readmissions within 28 days of discharge following RP were explored.

Results: Over the study period 9096 prostate cancers were diagnosed in men under 70, 26.5% of whom had RP by end of follow-up 31/12/2009. Two of eight public hospitals and eight of forty surgeons carried out 50% of all public-service RPs. Median LOS was 8 days (10th-90th percentile = 6-13 days) and fell significantly over time (2002, 9 days; 2008, 7 days; p < 0.001). In adjusted analyses men who were not married (OR = 1.71, 95% CI 1.25-2.34), had co-morbidities (OR = 1.64, 95% CI 1.25-2.16) or stage III-IV cancer (OR = 2.19, 95% CI 1.44-3.34) were significantly more likely to have prolonged LOS. Those treated in higher volume hospitals (annual median >49 RPs) or by higher volume surgeons (annual median >17 RPs) were significantly less likely to have prolonged LOS (OR = 0.34, 95% CI 0.26-0.45; OR = 0.55, 95% CI 0.42-0.71 respectively).

Conclusion: Median LOS after RP decreased between 2002 and 2008 in Ireland but it remains higher than in both England and the US. Although volumes of RPs conducted in Ireland are low, there is considerable variation between hospitals and surgeons. Hospital and surgeon volume were strong predictors of shorter LOS, after adjusting for other variables. These factors point to a need for a comprehensive review of prostate cancer service provision.

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Radical prostatectomy in men aged < 70 years at diagnosis, 2002–2008, dataset overview.
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Figure 1: Radical prostatectomy in men aged < 70 years at diagnosis, 2002–2008, dataset overview.

Mentions: Figure 1 provides an overview of the creation of the analysis dataset. Prostate cancers (ICD10-O3: C61) newly diagnosed between 2002 and 2008 were identified from the NCR. Since RP is rarely conducted in older men [23], the dataset was then limited to men aged < 70 years at diagnosis who had a RP (ICD 9 CM procedure codes 60.3, 60.4, 60.5, 60.62) recorded by the NCR before the end of follow-up on the 31/12/2009. Using probabilistic matching techniques, these prostate cancers were linked to HIPE episodes. We excluded 94 men who had RP in a public hospital but had a previous diagnosis of cancer; 63 of these 94 men were diagnosed in the 12 months prior to the prostate cancer diagnosis. Almost all of the cancers (95%) that occurred in the year prior to the prostate cancer diagnosis were bladder cancer (C67).


Factors predicting hospital length-of-stay after radical prostatectomy: a population-based study.

Kelly M, Sharp L, Dwane F, Kelleher T, Drummond FJ, Comber H - BMC Health Serv Res (2013)

Radical prostatectomy in men aged < 70 years at diagnosis, 2002–2008, dataset overview.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750445&req=5

Figure 1: Radical prostatectomy in men aged < 70 years at diagnosis, 2002–2008, dataset overview.
Mentions: Figure 1 provides an overview of the creation of the analysis dataset. Prostate cancers (ICD10-O3: C61) newly diagnosed between 2002 and 2008 were identified from the NCR. Since RP is rarely conducted in older men [23], the dataset was then limited to men aged < 70 years at diagnosis who had a RP (ICD 9 CM procedure codes 60.3, 60.4, 60.5, 60.62) recorded by the NCR before the end of follow-up on the 31/12/2009. Using probabilistic matching techniques, these prostate cancers were linked to HIPE episodes. We excluded 94 men who had RP in a public hospital but had a previous diagnosis of cancer; 63 of these 94 men were diagnosed in the 12 months prior to the prostate cancer diagnosis. Almost all of the cancers (95%) that occurred in the year prior to the prostate cancer diagnosis were bladder cancer (C67).

Bottom Line: For those who had RP (ICD-9 CM procedure codes 60.3, 60.4, 60.5, 60.62) the associated hospital episode was identified.Median LOS was 8 days (10th-90th percentile = 6-13 days) and fell significantly over time (2002, 9 days; 2008, 7 days; p < 0.001).Median LOS after RP decreased between 2002 and 2008 in Ireland but it remains higher than in both England and the US.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Radical prostatectomy (RP) is a leading treatment option for localised prostate cancer. Although hospital in-patient stays accounts for much of the costs of treatment, little is known about population-level trends in length-of-stay (LOS). We investigated factors predicting hospital LOS and readmissions in men who had RP following prostate cancer.

Methods: Incident prostate cancers (ICD-O3: C61), diagnosed January 2002-December 2008 in men < 70 years, were identified from the Irish Cancer Registry, and linked to public hospital episodes. For those who had RP (ICD-9 CM procedure codes 60.3, 60.4, 60.5, 60.62) the associated hospital episode was identified. LOS was calculated as the number of days from date of admission to date of discharge. Patient-, tumour-, and health service-related factors predicting longer LOS (upper quartile, >9 days) were investigated using logistic regression. Patterns in day-case and in-patient readmissions within 28 days of discharge following RP were explored.

Results: Over the study period 9096 prostate cancers were diagnosed in men under 70, 26.5% of whom had RP by end of follow-up 31/12/2009. Two of eight public hospitals and eight of forty surgeons carried out 50% of all public-service RPs. Median LOS was 8 days (10th-90th percentile = 6-13 days) and fell significantly over time (2002, 9 days; 2008, 7 days; p < 0.001). In adjusted analyses men who were not married (OR = 1.71, 95% CI 1.25-2.34), had co-morbidities (OR = 1.64, 95% CI 1.25-2.16) or stage III-IV cancer (OR = 2.19, 95% CI 1.44-3.34) were significantly more likely to have prolonged LOS. Those treated in higher volume hospitals (annual median >49 RPs) or by higher volume surgeons (annual median >17 RPs) were significantly less likely to have prolonged LOS (OR = 0.34, 95% CI 0.26-0.45; OR = 0.55, 95% CI 0.42-0.71 respectively).

Conclusion: Median LOS after RP decreased between 2002 and 2008 in Ireland but it remains higher than in both England and the US. Although volumes of RPs conducted in Ireland are low, there is considerable variation between hospitals and surgeons. Hospital and surgeon volume were strong predictors of shorter LOS, after adjusting for other variables. These factors point to a need for a comprehensive review of prostate cancer service provision.

Show MeSH
Related in: MedlinePlus