Sebastiano Nazzani1, Felix Preisser2, Elio Mazzone3, Zhe Tian4, Francesco A Mistretta5, Shahrokh F Shariat6, Fred Saad4, Markus Graefen7, Derya Tilki8, Emanuele Montanari9, Stefano Luzzago9, Alberto Briganti10, Luca Carmignani11, Pierre I Karakiewicz12. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. Electronic address: sebastiano.nazzani@yahoo.com. 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg- Eppendorf, Hamburg, Germany. 3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy. 4. Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada. 5. Department of Urology, Istituto Europeo di Oncologia, Milan, Italy. 6. Department of Urology, Medical University of Vienna, Vienna, Austria. 7. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg- Eppendorf, Hamburg, Germany. 8. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg- Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg- Eppendorf, Hamburg, Germany. 9. Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico University of Milan, Milan, Italy. 10. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy. 11. Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. 12. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada.
Abstract
BACKGROUND AND OBJECTIVES: Enhanced recovery after surgery protocols (ERAS) have been developed and implemented as of 2001. However, no previous analyses targeted length of stay (LOS) changes over time after major surgical oncological procedures (MSOPs). METHODS: Between 2003 and 2013, we retrospectively identified patients, who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection or pancreatectomy within the Nationwide Inpatient Sample. A total of 3 431 602 assessable patients were identified. We examined temporal trends of LOS after ten MSOPs, as well as LOS determinants and the impact of LOS on total hospital charges (THCGs). Univariable and multivariable linear, log-linear, logistic (MLR) and Poisson regression (MPR) analyses were used. RESULTS: Mean and median LOS were respectively 6 and 4 days (IQR 2-7). During the study span, LOS decreased [Estimated annual percentage change (EAPC): -1.89%, p = 0.0002]. Of the ten examined MSOPs, nine showed a decrease that ranged from -4.47% in prostatectomy to -0.7% in mastectomy. Conversely, no decrease in LOS was recorded for colectomy (EAPC:+0.37, p = 0.015). In MPR analyses, robotic [Relative risk (RR):0.68, p = 0.0003] and laparoscopic (RR: 0.90, p < 0.0001) surgical approaches were associated with shorter LOS. LOS was directly related to THCGs. CONCLUSIONS: Since the implementation of ERAS protocols, LOS has decreased for nine out of ten MSOPs in a significant fashion. Although these gains may appear marginal on an annual basis, their cumulative effect, over the study span, ranges for 7.7%-49.2%, which can hardly be interpreted as marginal. LOS decrease directly translates in THCGs savings.
BACKGROUND AND OBJECTIVES: Enhanced recovery after surgery protocols (ERAS) have been developed and implemented as of 2001. However, no previous analyses targeted length of stay (LOS) changes over time after major surgical oncological procedures (MSOPs). METHODS: Between 2003 and 2013, we retrospectively identified patients, who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection or pancreatectomy within the Nationwide Inpatient Sample. A total of 3 431 602 assessable patients were identified. We examined temporal trends of LOS after ten MSOPs, as well as LOS determinants and the impact of LOS on total hospital charges (THCGs). Univariable and multivariable linear, log-linear, logistic (MLR) and Poisson regression (MPR) analyses were used. RESULTS: Mean and median LOS were respectively 6 and 4 days (IQR 2-7). During the study span, LOS decreased [Estimated annual percentage change (EAPC): -1.89%, p = 0.0002]. Of the ten examined MSOPs, nine showed a decrease that ranged from -4.47% in prostatectomy to -0.7% in mastectomy. Conversely, no decrease in LOS was recorded for colectomy (EAPC:+0.37, p = 0.015). In MPR analyses, robotic [Relative risk (RR):0.68, p = 0.0003] and laparoscopic (RR: 0.90, p < 0.0001) surgical approaches were associated with shorter LOS. LOS was directly related to THCGs. CONCLUSIONS: Since the implementation of ERAS protocols, LOS has decreased for nine out of ten MSOPs in a significant fashion. Although these gains may appear marginal on an annual basis, their cumulative effect, over the study span, ranges for 7.7%-49.2%, which can hardly be interpreted as marginal. LOS decrease directly translates in THCGs savings.
Authors: Felix Preisser; Sebastiano Nazzani; Elio Mazzone; Sophie Knipper; Marco Bandini; Zhe Tian; Alexander Haese; Fred Saad; Kevin C Zorn; Francesco Montorsi; Shahrokh F Shariat; Markus Graefen; Derya Tilki; Pierre I Karakiewicz Journal: World J Urol Date: 2018-10-12 Impact factor: 4.226
Authors: Marco Bandini; Michele Marchioni; Felix Preisser; Sebastiano Nazzani; Zhe Tian; Markus Graefen; Francesco Montorsi; Fred Saad; Shahrokh F Shariat; Luigi Schips; Alberto Briganti; Pierre I Karakiewicz Journal: Can Urol Assoc J Date: 2019-09-27 Impact factor: 1.862
Authors: Patrick Téoule; Laura Römling; Matthias Schwarzbach; Emrullah Birgin; Felix Rückert; Torsten J Wilhelm; Marco Niedergethmann; Stefan Post; Nuh N Rahbari; Christoph Reißfelder; Ulrich Ronellenfitsch Journal: Ther Clin Risk Manag Date: 2019-10-01 Impact factor: 2.423