Rohan G Bhalla1, Li Wang2, Sam S Chang3, Mark D Tyson3. 1. Vanderbilt University School of Medicine, Nashville, Tennessee. Electronic address: rohan.g.bhalla@vanderbilt.edu. 2. Department of Biostatistics, Nashville, Tennessee. 3. Department of Urologic Surgery, Nashville, Tennessee.
Abstract
PURPOSE: Using contemporary population based epidemiological data we measured the relationship between the preoperative serum albumin level and hospital length of stay after cystectomy and urinary diversion. MATERIALS AND METHODS: Data were acquired from the 2014 to 2015 NSQIP® (National Surgical Quality Improvement Program®) database. We identified 1,582 adults who underwent cystectomy between January 1, 2014 and December 31, 2015, and had a documented preoperative serum albumin level. The primary outcome was time to hospital discharge and the primary exposure was preoperative serum albumin. We fit a Cox proportional hazards model to assess associations with adjustment for a set of predefined confounders. We allowed for all continuous variables to have a nonlinear relationship with the primary outcome using a restricted cubic spline with 3 knots. RESULTS: Preoperative serum albumin was independently associated with hospital length of stay after cystectomy. Increasing preoperative serum albumin below a threshold of 4 gm/dl was associated with decreased length of stay (HR 1.05, 95% CI 1.01-1.09, p <0.004). Other significant predictors associated with longer length of stay included patient age (HR 0.84, 95% CI 0.77-0.91, p <0.001), nonCaucasian race (HR 0.81, 95% CI 0.70-0.93, p = 0.003) and American College of Surgeons classification 4 (class 4 vs 3 HR 0.78, 95% CI 0.62-0.97, p = 0.008). Minimally invasive cystectomy was associated with a shorter length of stay (HR 1.23, 95% CI 1.07-1.42, p = 0.004). CONCLUSIONS: This study provides evidence that nutritional optimization prior to cystectomy shortens the length of stay after surgery but there are diminishing returns above a threshold of 4 gm/dl.
PURPOSE: Using contemporary population based epidemiological data we measured the relationship between the preoperative serum albumin level and hospital length of stay after cystectomy and urinary diversion. MATERIALS AND METHODS: Data were acquired from the 2014 to 2015 NSQIP® (National Surgical Quality Improvement Program®) database. We identified 1,582 adults who underwent cystectomy between January 1, 2014 and December 31, 2015, and had a documented preoperative serum albumin level. The primary outcome was time to hospital discharge and the primary exposure was preoperative serum albumin. We fit a Cox proportional hazards model to assess associations with adjustment for a set of predefined confounders. We allowed for all continuous variables to have a nonlinear relationship with the primary outcome using a restricted cubic spline with 3 knots. RESULTS: Preoperative serum albumin was independently associated with hospital length of stay after cystectomy. Increasing preoperative serum albumin below a threshold of 4 gm/dl was associated with decreased length of stay (HR 1.05, 95% CI 1.01-1.09, p <0.004). Other significant predictors associated with longer length of stay included patient age (HR 0.84, 95% CI 0.77-0.91, p <0.001), nonCaucasian race (HR 0.81, 95% CI 0.70-0.93, p = 0.003) and American College of Surgeons classification 4 (class 4 vs 3 HR 0.78, 95% CI 0.62-0.97, p = 0.008). Minimally invasive cystectomy was associated with a shorter length of stay (HR 1.23, 95% CI 1.07-1.42, p = 0.004). CONCLUSIONS: This study provides evidence that nutritional optimization prior to cystectomy shortens the length of stay after surgery but there are diminishing returns above a threshold of 4 gm/dl.
Authors: Khodayar Goshtasbi; Jack L Birkenbeuel; Mehdi Abouzari; Brandon M Lehrich; Tyler M Yasaka; Arash Abiri; Ethan G Muhonen; Frank P K Hsu; Edward C Kuan Journal: Am J Rhinol Allergy Date: 2020-10-29 Impact factor: 2.467