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Influence of Preoperative and Postoperative Factors on Prolonged Length of Stay and Readmission After Minimally

Robert R A Wilson1, Ashok Hemal2, Shuo Liu3

  • 1Department of Surgery, University of Kentucky School of Medicine, Lexington, Kentucky, USA.

Journal of Endourology
|September 22, 2021
PubMed

Insights

Minimally invasive radical prostatectomy patients with heart failure or high BMI face longer hospital stays and readmissions. Addressing these preoperative factors is key to improving outcomes after prostate surgery.

Area of Science:

  • Urology
  • Surgical Quality Improvement
  • Health Services Research

Background:

  • Minimally invasive radical prostatectomy (MI-RP) typically involves a short hospital stay (<2 days).
  • Identifying factors predicting prolonged length of stay (LOS) and readmission is crucial for optimizing patient care.
  • The National Surgical Quality Improvement Program (NSQIP) database offers a robust platform for such analyses.

Purpose of the Study:

  • To evaluate preoperative factors associated with prolonged LOS and 30-day hospital readmission after MI-RP.
  • To identify specific patient comorbidities and characteristics that increase the risk of adverse postoperative outcomes.
  • To inform preoperative counseling and risk mitigation strategies for patients undergoing MI-RP.

Main Methods:

  • Analysis of the NSQIP database for patients who underwent MI-RP (CPT code 55866) between 2007 and 2017.
  • Statistical evaluation using Chi-square and t-tests to compare groups based on LOS and readmission rates.
  • Multivariable logistic regression to determine odds ratios (ORs) for preoperative factors influencing prolonged LOS and readmission.

Main Results:

  • A total of 40,764 MI-RP cases were analyzed; 11.7% had LOS >2 days, and 3.9% were readmitted within 30 days.
  • Preoperative congestive heart failure significantly increased the odds of prolonged LOS (OR=6.16) and readmission (OR=3.28).
  • High body mass index (BMI >30) was associated with both prolonged LOS and increased readmission; postoperative bleeding and unplanned intubation were major drivers of prolonged LOS and readmission, respectively.

Conclusions:

  • Cardiopulmonary factors and elevated BMI negatively impact postoperative quality indicators following MI-RP.
  • Preoperative identification and counseling regarding individual risk factors, such as comorbidities, are essential.
  • Mitigating identified risk factors can lead to improved patient outcomes and reduced healthcare resource utilization.
Keywords:
length of staypatient readmissionpostoperative complicationsprostatectomyrobotic surgical procedures

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