title: Discharge patterns after radical prostatectomy in the United States of America.
abstract: OBJECTIVE
  Discharge patterns, including prolonged length of stay (LOS) and adverse discharge disposition (ADD), are important clinical indicators of quality of care. We examined the effect of several indicators on discharge patterns after radical prostatectomy (RP).
  
  
  METHODS
  Within the Nationwide Inpatient Sample, we focused on RPs performed between 2001 and 2007. Multivariable logistic regression analyses predicting the likelihood of prolonged LOS and ADD were performed.
  
  
  RESULTS
  Overall, 89,883 eligible RPs were identified, yielding a weighted national estimate of 442,400 eligible RPs. The rates of prolonged LOS decreased from 28.9 in the early period (2001-2003) to 14.4% in the late period (2006-2007) (P < 0.001). Similarly, the rates of ADD decreased from 7.4 in the early period to 5.0% in the late period (P < 0.001). In multivariable analyses adjusted for clustering, both annual hospital caseload (AHC) and insurance status were independent predictors of prolonged LOS and ADD. For example, RP performed at low AHC hospitals were more frequently associated with prolonged LOS than intermediate (OR = 0.45, P < 0.001) and high (OR = 0.21, P < 0.001) AHC hospitals. Similarly, RP performed at low AHC hospitals were more frequently associated with ADD than intermediate (OR = 0.54, P < 0.001) and high (OR = 0.63, P < 0.001) AHC hospitals.
  
  
  CONCLUSIONS
  An improving temporal trend in discharge patterns was recorded in patients undergoing RP, with significant reductions in the rates of prolonged LOS and ADD. Nonetheless, important disparities were recorded when discharge patterns were stratified according to insurance status and AHC. Specifically, shorter LOS and lower rates of ADD should be expected in patients with private insurance and/or treated at high AHC institutions.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. Electronic address: trinh.qd@gmail.com.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Jesse
authors.initials: J
authors.lastname: Sammon
authors.forename: Jan
authors.initials: J
authors.lastname: Schmitges
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Kevin
authors.initials: K
authors.lastname: Zorn
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data*; D063886:Patient Discharge Summaries / Q000706:statistics & numerical data*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D014481:United States