Influence of Preoperative and Postoperative Factors on Prolonged Length of Stay and Readmission After Minimally Invasive Radical Prostatectomy.

Abstract

Background: The mean length of stay (LOS) after minimally invasive radical prostatectomy (MI-RP) is <2 days. Our main objective was to utilize the National Surgical Quality Improvement Program (NSQIP) database to evaluate preoperative factors that may contribute to prolonged hospital stay and readmission. Materials and Methods: Utilizing the NSQIP database, records for surgery with the Current Procedural Terminology code 55866 (prostatectomy) between 2007 and 2017 were evaluated. Chi-square and t-tests were used to assess the effects of preoperative factors on prolonged LOS and rates of hospital readmission within 30 days. Odds ratios (ORs), p-values, and confidence intervals were determined using multivariable logistic regression. Results: A total of 40,764 patients underwent MI-RP between 2007 and 2017. Of these, 11.7% reported an LOS of >2 days, whereas 3.9% of patients were readmitted to the hospital within 30 days. Preoperative congestive heart failure within 30 days of surgery was shown to be strongly associated with both prolonged LOS (OR = 6.16) and readmission (OR = 3.28). Bleeding requiring transfusion was demonstrated to be the most significant postoperative factor for prolonged LOS (OR = 23.9), whereas unplanned intubation was shown to be the most significant postoperative factor for readmission (OR = 57.1). Body mass index (BMI) >30 was associated with both prolonged LOS and increase in readmission. Conclusions: Upon NSQIP database analysis, cardiopulmonary factors and BMI were demonstrated to have negative impacts on postoperative quality indicators. Patients with comorbidities should be counseled preoperatively concerning their individual risk factors. Mitigation of these factors is important in ensuring optimal outcomes.