Discharge practice patterns following cystectomy for bladder cancer: evidence for the shifting of the burden of care.
OBJECTIVE
Between 1985 and 2000 the incidence of bladder cancer in this country increased by 33%. Radical cystectomy is the primary treatment modality in patients with invasive disease. We characterized trends in cystectomy use and discharge practice patterns following cystectomy during a recent 13-year period.


METHODS
The Nationwide Inpatient Sample comprises a 20% probability sample of hospital discharges in the United States each year. Patients who underwent cystectomy for bladder cancer from 1988 to 2000 were identified using International Classification of Disease, 9th Revision, Clinical Modification codes. Outcome variables included in-hospital mortality, length of stay and hospital discharge status.


RESULTS
From 1988 to 2000 an estimated 119,491 patients underwent cystectomy for bladder cancer. Cystectomy rates decreased by 17% from 3.91/100,000 (1988 to 1990) to 3.25/100,000 (1997 to 2000), largely due to a decreasing number of partial cystectomies. In-hospital mortality decreased from 3.3% (1988 to 1990) to 2.5% (1997 to 2000) (p = 0.027). Similarly median length of stay decreased from 13 days (1988 to 1990) to 9 (1997 to 2000) (p <0.001). During the same period the percent of patients being discharged to subacute care facilities increased from 5.3% to 13.2% (p <0.001), as did the percent of patients requiring home health care services (24.1% to 38.7%, p <0.001).


CONCLUSIONS
From 1988 to 2000 there was a decrease in the rate of cystectomies being performed for bladder cancer with a substantial decrease in partial cystectomy use. During this period short-term outcomes following cystectomy improved, while the use of subacute care facilities and home health services increased dramatically, underscoring a shift in the burden of care in this patient population.
Taub
David A
DA
Department of Urology and Division of Clinical Research and Quality Assurance, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
Dunn
Rodney L
RL
Miller
David C
DC
Wei
John T
JT
Hollenbeck
Brent K
BK
D000359:Aftercare / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography; D019538:Health Care Surveys; D006699:Home Care Services / Q000706:statistics & numerical data; D017721:Hospital Costs; D017052:Hospital Mortality; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*