110 NEOADJUVANT CHEMOTHERAPY AS A PREDICTOR OF COST, READMISSION, AND LENGTH OF STAY IN RADICAL CYSTECTOMY PATIENTS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes III1 Apr 2010110 NEOADJUVANT CHEMOTHERAPY AS A PREDICTOR OF COST, READMISSION, AND LENGTH OF STAY IN RADICAL CYSTECTOMY PATIENTS Deep Trivedi, Jennifer Gordetsky, Guan Wu, Changyong Feng, Susan Messing, Nathaniel Robbins, Thomas Pashalides, Ingrid Mikk, Hani Rashid, Dragan Golijanin, Katia Noyes, and Edward Messing Deep TrivediDeep Trivedi More articles by this author , Jennifer GordetskyJennifer Gordetsky More articles by this author , Guan WuGuan Wu More articles by this author , Changyong FengChangyong Feng More articles by this author , Susan MessingSusan Messing More articles by this author , Nathaniel RobbinsNathaniel Robbins More articles by this author , Thomas PashalidesThomas Pashalides More articles by this author , Ingrid MikkIngrid Mikk More articles by this author , Hani RashidHani Rashid More articles by this author , Dragan GolijaninDragan Golijanin More articles by this author , Katia NoyesKatia Noyes More articles by this author , and Edward MessingEdward Messing More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.160AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is evidence that receiving neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) results in improved survival over surgery alone in patients with high-stage, muscle invasive bladder cancer. NAC may be underutilized, however, due to reported concerns of increased perioperative complications. Little data exist on whether NAC affects post-operative hospitalization cost, length of stay (LOS), or readmission rate in this group of patients. METHODS Retrospective billing record and medical chart review of 150 consecutive patients who underwent RC from 1/2006 to 12/2008 was conducted to assess the association between receipt of NAC and initial post-surgical LOS, American Society of Anesthesiologists (ASA) score (when available), intraoperative parameters, and patient demographics. To adjust for the effect of outliers, adjusted LOS was calculated as the mean of LOS values excluding the top 10%. Association between the above variables of interest and use of NAC was examined using Student t-test. Pearson'chi-squared test was used to explore the association between NAC receipt and 90-day readmission status. RESULTS Two-sample t-tests showed a significant difference in operative time, but no difference in age, mean ASA score, estimated blood loss (EBL), LOS, adjusted LOS, or total post-surgical hospitalization cost between recipents and non-recipents of NAC. Pearson's chi-square test showed no difference in readmission rate (30.23% vs. 25.00%, p=0.63) between these groups. (See table) Variable NeoAdj=No NeoAdj=Yes P-value N Mean SD N Mean SD Age 129 70.26 9.09 20 66.65 13.39 0.13 ASA 102 2.59 0.637 17 2.57 0.712 0.11 EBL (mL) 123 1381.70 2027.05 19 2071.05 3574.26 0.21 Op Time (min) 111 460.24 104.58 17 512.53 93.89 0.02* Median LOS 127 8 - 20 11 - - Adj. LOS 115 9 3.91 18 10.9 4.49 0.05 Overall LOS 127 11.46 10.17 20 21.85 7.69 0.48 Total cost ($) 129 $48,469.00 36,198.00 20 48,850.00 17,146.00 0.94 CONCLUSIONS In this series, NAC predicts increased operative time but has no significant impact on the readmission rate, duration or cost of initial hospitalization in patients undergoing RC. Rochester, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e45 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Deep Trivedi More articles by this author Jennifer Gordetsky More articles by this author Guan Wu More articles by this author Changyong Feng More articles by this author Susan Messing More articles by this author Nathaniel Robbins More articles by this author Thomas Pashalides More articles by this author Ingrid Mikk More articles by this author Hani Rashid More articles by this author Dragan Golijanin More articles by this author Katia Noyes More articles by this author Edward Messing More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...