Discharge patterns after radical cystectomy: contemporary trends in the United States

Purpose: Discharge patterns, including rates of prolonged length of stay and transfer to a facility, were evaluated in the context of radical cystectomy. Materials and Methods: Within the Nationwide Inpatient Sample we focused on radical cystectomy performed between 1998 and 2007. Multivariable logistic regression analyses predicting the likelihood of prolonged length of stay or transfer to a facility were performed. Results: Overall 11,876 eligible radical cystectomy cases were identified. The rates of prolonged length of stay decreased from 59% in the early period (1998 to 2001) to 50% in the late period (2005 to 2007, p < 0.001) while the rates of transfer to a facility remained stable (14%). On multivariable analyses adjusted for clustering, prolonged length of stay was more frequently recorded in patients from low annual caseload hospitals (OR 1.42, p < 0.001), as well as in Medicaid and Medicare patients (OR 1.66 and 1.17, respectively, all p < 0.01). Similarly rates of transfer to a facility were significantly higher for patients from low annual caseload hospitals (OR 1.81, p < 0.001) and for those with Medicaid or Medicare (OR 2.18 and 1.54, respectively, all p < 0.001), as well as for patients treated at nonacademic institutions (OR 1.31, p < 0.001). Conclusions: It is encouraging that the rates of prolonged length of stay have decreased while the rates of transfer to a facility remained stable. However, it is worrisome that individuals treated at low annual caseload centers as well as those with Medicare and Medicaid insurance experience less favorable discharge patterns.