title: Factors influencing the length of stay after radical cystectomy: implications for cancer care and perioperative management.
abstract: BACKGROUND
  Although radical cystectomy (RC) is the gold standard treatment for muscle invasive bladder cancer it is associated with perioperative complications, readmissions, and a prolonged length of hospital stay (PLOS). We explored the perioperative factors associated with a PLOS after RC and subsequent long-term outcomes.
  
  
  METHODS
  Consecutive patients with urothelial bladder cancer undergoing RC with curative intent at our institution were classified into two groups: LOS <12 days and PLOS ≥12 days. Clinicopathological variables were compared on univariate and multivariable analysis. Complications, re-admissions, adjuvant chemotherapy use, recurrence free survival (RFS), and overall survival (OS) were compared between the two groups. Competing risk analysis was performed for bladder cancer specific mortality (BCSM).
  
  
  RESULTS
  330 patients were included in the analysis (median LOS = 9 days [IQR = 8-11]) of which, 274 patients (83 %) had a LOS <12 days (median = 8 days [IQR = 7-10]) and 56 patients (17 %) had a PLOS ≥12 days (median = 16 days [IQR = 13-21.5]). Only female gender, older age, and perioperative complications were associated with a PLOS. 90 day readmission rates were similar (p = 0.75). No difference was seen for BCSM, RFS, or adjuvant chemotherapy usage between the two groups. However, OS was significantly worse for PLOS (median OS = 27.7 vs. 45.6 months [p = 0.046]; HR = 1.53 [95 % CI = 1.01-2.33]).
  
  
  CONCLUSIONS
  Both female and elderly patients should receive preoperative counseling about their increased risk of a PLOS after RC. Patients who experience a PLOS are at greater risk for subsequent all-cause mortality. These patient groups may benefit from proactive interventions.
authors.affiliation: Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA, eugene.pietzak@uphs.upenn.edu.
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Pietzak
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Hwang
authors.forename: S Bruce
authors.initials: SB
authors.lastname: Malkowicz
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Guzzo
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000401:mortality*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D019990:Perioperative Care; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*