title: Discharge patterns after radical cystectomy: contemporary trends in the United States.
abstract: OBJECTIVE
  Discharge patterns, including rates of prolonged length of stay and transfer to a facility, were evaluated in the context of radical cystectomy.
  
  
  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.
authors.affiliation: Department of Urology, Vita Salute San Raffaele University, Urologic Research Institute, Milan, Italy. bianchihsr@gmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
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: Khurshid R
authors.initials: KR
authors.lastname: Ghani
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
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; D015653:Cystectomy; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends*; D010360:Patient Transfer / Q000706:statistics & numerical data; D014481:United States