title: Hospitalization trends after prostate and bladder surgery: implications of potential payment reforms.
abstract: OBJECTIVE
  Hospital stays have decreased for patients undergoing surgery for urological cancer. However, there are concerns that patients are being discharged from the hospital prematurely. We examined associations between hospital stay and short-term outcomes for a low risk procedure (prostatectomy) and high risk procedure (cystectomy).
  
  
  METHODS
  We used SEER (Surveillance, Epidemiology and End Results)-Medicare data from 1992 through 2005 to identify 46,781 prostatectomy and 9,035 cystectomy cases. We assessed our main outcome (adjusted likelihood of hospital readmission within 30 days) using a logistic regression model. Secondary outcomes included mortality rates and discharge disposition.
  
  
  RESULTS
  In comparing patients from 1992 to 1993, to 2004 to 2005, hospital stay decreased approximately 3 days for both surgeries (relative decrease of more than 50% for prostatectomy and 21% for cystectomy). Hospital readmission rates were 4.5% and 25.2% for prostatectomy and cystectomy, respectively, and remained stable with time. Skilled nursing/intermediate care use was stable for patients who underwent prostatectomy (approximately 1%), but increased from 8.2% (95% CI 5.4-11.4) to 18.9% (95% CI 16.8-21.3) for those treated with cystectomy. Use of home care increased from 8.1% (95% CI 7.3-9.0) to 11.1% (95% CI 10.1-12.1) and from 34.2% (95% CI 29.7-38.7) to 47.5% (95% CI 44.5-50.1) for prostatectomy and cystectomy cases, respectively.
  
  
  CONCLUSIONS
  Reductions in hospital stay were more dramatic for patients who underwent prostatectomy and were associated with stable short-term outcomes. Conversely, smaller reductions in hospitalization for patients undergoing cystectomy were met with substantial increases in the use of post-acute care. Going forward, close surveillance of how imminent policy reforms affect patterns and quality of care will be necessary.
authors.affiliation: Department of Urology, Division of Oncology, University of Michigan, Ann Arbor, Michigan 48109-2800, USA. brucejac@med.umich.edu
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Tan
authors.forename: Zaojun
authors.initials: Z
authors.lastname: Ye
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
mesh_terms: D000368:Aged; D015653:Cystectomy; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data* / Q000639:trends*; D011468:Prostatectomy; D012051:Reimbursement Mechanisms / Q000592:standards*