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Objective <p>To test contemporary rates and predictors of prolonged hospital stay after radical cystectomy (RC) and ileal conduit in non-metastatic bladder cancer patients.</p> Methods <p>Within the National Inpatient Sample database (NIS, 2008–2019), we identified ileal conduit RC patients and tabulated length of stay (LOS) ≥ 75th percentile vs. others. Temporal trends and multivariable logistic regression models (LRM) were fitted.</p> Results <p>Of 10,934 patients, 3,116 (28%) exhibited LOS ≥ 75th percentile (≥ 10&#xa0;days), with rates decreasing from 35.4% in 2008 to 20.0% in 2019 (p &lt; 0.001). In multivariable LRM, independent predictors of LOS ≥ 75th percentile were age ≥ 80&#xa0;years (OR 1.37), CCI ≥ 2 (OR 1.55), coagulopathy (OR 1.55), obesity (OR 1.15), African American race/ethnicity (OR 1.57), female sex (OR 1.17), Medicare (OR 1.24) or Medicaid (OR 1.41) insurance, and treatment at low- (OR 1.68) or medium-volume hospitals (OR 1.33). Conversely, minimally invasive surgery (OR 0.59) exhibited the opposite protective effect (all p ≤ 0.03). Interestingly, the combined effect of age (≥ 80 vs. &lt; 80&#xa0;years) and surgical approach (minimally invasive vs. open) also achieved independent predictive status. Specifically, patients aged ≥ 80 undergoing minimally invasive, &lt; 80 undergoing open, and ≥ 80 undergoing open surgery were, respectively, 1.35, 1.65, and 2.29 times more likely to require LOS ≥ 75th percentile compared to those aged &lt; 80 undergoing minimally invasive surgery (all p ≤ 0.004).</p> Conclusion <p>The proportion requiring LOS ≥ 75th percentile decreased over time. Multivariable LRMs showed that age, race, insurance, hospital characteristics, and surgical approach were significantly associated with LOS ≥ 75th percentile. Combinations of variables, such as age ≥ 80 and open surgery, identified higher-risk subgroups.</p>

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Contemporary rates and predictors of prolonged hospital stay after radical cystectomy: a population-based analysis

  • 期刊论文

  • 发表日期：

    2025年8月8日

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  • Natali Rodriguez Peñaranda,
  • Fabian Falkenbach,
  • Andrea Marmiroli,
  • Mattia Longoni,
  • Quynh Chi Le,
  • Calogero Catanzaro,
  • Michele Nicolazzini,
  • Francesco Di Bello,
  • Jordan A. Goyal,
  • Fred Saad,
  • Shahrokh F. Shariat,
  • Gennaro Musi,
  • Markus Graefen,
  • Alberto Briganti,
  • Felix K. H. Chun,
  • Riccardo Schiavina,
  • Alessandro Volpe,
  • Stefano Resca,
  • Ivan Matteo Tavolini,
  • Stefano Puliatti,
  • Salvatore Micali,
  • Pierre I. Karakiewicz

摘要

Objective

To test contemporary rates and predictors of prolonged hospital stay after radical cystectomy (RC) and ileal conduit in non-metastatic bladder cancer patients.

Methods

Within the National Inpatient Sample database (NIS, 2008–2019), we identified ileal conduit RC patients and tabulated length of stay (LOS) ≥ 75th percentile vs. others. Temporal trends and multivariable logistic regression models (LRM) were fitted.

Results

Of 10,934 patients, 3,116 (28%) exhibited LOS ≥ 75th percentile (≥ 10 days), with rates decreasing from 35.4% in 2008 to 20.0% in 2019 (p < 0.001). In multivariable LRM, independent predictors of LOS ≥ 75th percentile were age ≥ 80 years (OR 1.37), CCI ≥ 2 (OR 1.55), coagulopathy (OR 1.55), obesity (OR 1.15), African American race/ethnicity (OR 1.57), female sex (OR 1.17), Medicare (OR 1.24) or Medicaid (OR 1.41) insurance, and treatment at low- (OR 1.68) or medium-volume hospitals (OR 1.33). Conversely, minimally invasive surgery (OR 0.59) exhibited the opposite protective effect (all p ≤ 0.03). Interestingly, the combined effect of age (≥ 80 vs. < 80 years) and surgical approach (minimally invasive vs. open) also achieved independent predictive status. Specifically, patients aged ≥ 80 undergoing minimally invasive, < 80 undergoing open, and ≥ 80 undergoing open surgery were, respectively, 1.35, 1.65, and 2.29 times more likely to require LOS ≥ 75th percentile compared to those aged < 80 undergoing minimally invasive surgery (all p ≤ 0.004).

Conclusion

The proportion requiring LOS ≥ 75th percentile decreased over time. Multivariable LRMs showed that age, race, insurance, hospital characteristics, and surgical approach were significantly associated with LOS ≥ 75th percentile. Combinations of variables, such as age ≥ 80 and open surgery, identified higher-risk subgroups.