Gender and age differences in blood utilization and length of stay in radical cystectomy: a population-based study.
OBJECTIVE
Radical cystectomy is a major surgical procedure associated with significant blood loss and lengthy hospital stays. This surgical procedure is more challenging in women than men due to anatomical-based differences. We evaluated resource utilization and complication rates of patients undergoing radical cystectomy or exenteration using the Texas Hospital In-Patient Discharge Data Collection.


METHODS
This was a retrospective study of 1,493 patients, 35 years of age or older, who underwent radical cystectomy for bladder cancer from January 2000 to December 2003. We evaluated blood product charges, length of stay, and complication rates during hospitalization.


RESULTS
In this sample, 24% of the patients (n = 356) were women. Overall, women had significantly increased blood product charges and length of stay compared to men, $1,392.87 vs. $718.21 (P < 0.001) and 12.72 vs. 11.64 (P = 0.03), respectively. During hospitalization, 26 of the patients died. No differences in mortality or complication rates were observed between men and women. Multivariate analysis showed that female sex (P < 0.001) and age (P = 0.003) were independent predictors of increased blood product charges. Multivariate analysis showed that female sex (P = 0.015), age (P = 0.003), and Charlson's comorbidity index >1 (P = 0.05) were predictors of longer length of stay.


CONCLUSIONS
Women and older patients with bladder cancer are at risk of increased blood products utilization and length of hospital stay after a radical cystectomy. Appropriate postoperative care and referrals should improve postoperative outcomes for these vulnerable patients.
Cárdenas-Turanzas
Marylou
M
Department of Biostatistics, Health Services Research, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Unit 447, Houston, TX, 77030-4009, USA. mcardena@mdanderson.org
Cooksley
Catherine
C
Kamat
Ashish M
AM
Pettaway
Curtis A
CA
Elting
Linda S
LS
D000328:Adult; D000367:Age Factors; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D015653:Cystectomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D016896:Treatment Outcome