title: Trends and Factors Influencing Inpatient Prolapse Surgical Costs and Length of Stay in the United States.
abstract: OBJECTIVE
  This study aimed to assess trends and factors affecting inpatient hospital costs and length of stay (LOS) in surgical treatment of pelvic organ prolapse in the United States.
  
  
  METHODS
  A retrospective cross-sectional study along with longitudinal trend analysis from the 2001 to 2011 National Inpatient Sample included subjects who underwent inpatient prolapse repairs. The primary outcomes were inpatient mean cost per admission and LOS. We compared unadjusted differences in primary outcomes for each patient and hospital characteristic using 2011 data with analysis of variance. Multivariable regression estimated proportional change in cost and LOS associated with each characteristic.
  
  
  RESULTS
  Unadjusted analysis revealed increased LOS with age of 80 years or older, African American race, uninsured status, lower income, and lower surgical volume hospitals (≤75%) as well as increased costs in the West and public hospitals. On multivariable analyses, African Americans had 1.09 (95% confidence interval [CI], 1.05-1.13; P < 0.001) times longer LOS compared with Caucasians, and the uninsured had 1.15 (95% CI, 1.01-1.30; P = 0.032) times longer LOS compared with those privately insured. Comorbidities associated with 20% increase in LOS and costs were pulmonary circulation disorders, metastatic cancer, weight loss, coagulopathy, and electrolyte/fluid imbalance (P < 0.001). Congestive heart failure and blood loss/deficiency anemia lead to 20% longer LOS (P < 0.001). In 2001-2011, mean LOS declined from 2.42 days (95% CI, 2.37-2.47) to 1.79 days (95% CI, 1.71-1.87) (P < 0.001), whereas mean total cost increased from $6233 (95% CI, $5859-$6607) to $9035 (95% CI, $8632-$9438) (P < 0.001).
  
  
  CONCLUSIONS
  Inpatient surgical costs for prolapse increased despite decreasing LOS. Some patient and hospital characteristics are associated with increased inpatient costs and LOS.
authors.affiliation: From the *University of Maryland School of Medicine, Baltimore, MD; †Case Western Reserve University, Cleveland, OH; and ‡University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: Tatiana V D
authors.initials: TV
authors.lastname: Sanses
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: Schiltz
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States