Operative duration as independent predictor of increased postoperative healthcare utilization.

Abstract

Few studies have examined the risk factors for postoperative healthcare resource utilization (HRU) among minimally invasive partial nephrectomy (MIPN), minimally invasive prostatectomy (MIP), and cystectomy (Cx). The aim of this study is to assess if operative duration (OD) is a predictor of HRU in this population. The ACS-NSQIPdatabase was filtered for MIPN, MIP, and Cx. Patient characteristics and intraoperative variableswere examined. HRU was defined as prolonged length of stay (LOS), unplanned readmission within 30days, and discharge to continued care facility. Multivariate regression analysis was used to identify independent predictors of HRU. 18,904 MIPN, 50,807 MIP, and 12,451 Cx were included. For MIPN, HRU was seen in 13.9% of cases < 1.75h, increasing to 36.2% in OD > 4.5h (p < 0.001). For MIP, HRU was seen in 10.6% of OD < 2h, increasing to 32.2% for OD > 4.9h (p < 0.001). For Cx, 57% of those with OD > 8.5h required HRU compared to 42.1% for OD < 3.3h (p < 0.001). On multivariate analyses, OD wasan independent predictor for increased HRU for all procedures regardless of patient characteristics or comorbidities. For MIPN, OD > 4.5h had 3.5-fold increased use of HRU (p < 0.001). For MIP, OD > 5h had 3.7-fold increased use of HRU (p < 0.001). For Cx, OD > 8.5h demonstrated a twofold increased use of HRU (p < 0.001). OD during MIPN, MIP, and Cx is an independent predictor of increased HRU irrespective of patient comorbidities. Patients with OD > 4.5h for MIPN, > 5h for MIP, and > 8.5h for Cx have 3.5-fold, 3.7-fold, and twofold increased risk of HRU, respectively.