Abstract
BackgroundHospital length of stay (LOS) has recently been receiving increasing attention as a marker of medical resource consumption. Identifying predictors of longer LOS can better equip doctors to counsel patients and facilitate more efficient patient flow and utilization of medical resources. The objective of this study was to identify pre- and intra-operative risk factors for postoperative hospital LOS in patients who had undergone radical prostatectomy in China.MethodsWe retrospectively analyzed data of 793 eligible patients with prostate cancer who had undergone radical prostatectomy in our institution between January 2011 and March 2016. Relevant preoperative variables, including patient characteristics, medical comorbidities, prostate cancer disease-specific variables, urinary tract symptoms, preoperative laboratory values, and intraoperative variables including operation type, operation duration, and blood loss, were analyzed. The outcome was postoperative length of stay which was calculated as the time from the date of operation to the date of discharge. Multiple linear regression analysis was used to identify predictors of this outcome.ResultsThe mean postoperative LOS was 11.7 days (±4.6 days) and the median 10 days (range, 5–46 days). According to univariate and multivariate analysis, operation type (open or laparoscopic), blood loss, Gleason score (≥8) and preoperative laboratory values of white blood count (WBC) were found to be the main explanatory predictors of postoperative LOS of patients with prostate cancer in our institution. Additionally, open surgery was the strongest significant predictor of longer LOS according to the standardized coefficients in this model.ConclusionsOur findings indicate that significant predictors of longer postoperative LOS in patients who have undergone radical prostatectomy in China include both preoperative variables of Gleason score, WBC and intraoperative variables of operation type (open or laparoscopic), blood loss. To shorten hospital LOS in patients with prostate cancer and optimize utilization of Chinese medical resources, efforts should be made to improve the intraoperative process and reduce the prevalence of preoperative risk factors.
Highlights
Hospital length of stay (LOS) has recently been receiving increasing attention as a marker of medical resource consumption
We found that the preoperative variables of biopsy Gleason score (≥ 8) and white blood count (WBC) and intraoperative variables of operation type, and blood loss are significant predictors of longer LOS for post-radical prostatectomy patients with prostate cancer in China
In China, the lack of post-hospitalization care such as that provided by rehabilitation centers and clinician’s follow-up checks, which are commonly available in Western countries [15, 17], lengthens the LOS
Summary
Hospital length of stay (LOS) has recently been receiving increasing attention as a marker of medical resource consumption. The objective of this study was to identify pre- and intra-operative risk factors for postoperative hospital LOS in patients who had undergone radical prostatectomy in China. Hospital length of stay (LOS) has been increasingly used as a marker for medical resource consumption [5,6,7]. Prolonged LOS is associated with higher medical costs and resource consumption [5, 8], but may place patients at greater risk of complications, including hospital-acquired infections and deep vein thrombosis [9, 10]. It is important to identify risk factors for prolonged LOS and provide strategies for shortening LOS and reducing unnecessary resource utilization
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