title: Potential Implications of Shortening Length of Stay Following Radical Cystectomy in a Pre-ERAS Population.
abstract: To investigate whether shortened inpatient length of stay (LOS) after radical cystectomy (RC) is associated with increased complication rates after hospital discharge.
  
  
  
  The analytic cohort comprised 484 consecutive patients with 90-day follow-up who underwent RC at our institution from 2005 to 2012 and with LOS ≤9 days. Patients were categorized according to LOS as short (s-LOS; ≤5 days) or routine (r-LOS; 6-9 days). The primary outcome was major complications (Clavien-Dindo grades 3-5) occurring within 90 days after discharge. A Cox proportional hazards model was used to determine the association between LOS and post-discharge major complications. Hospital readmission was a secondary outcome.
  
  
  
  Patients in the s-LOS cohort had fewer comorbidities (P < .01), less frequently received neoadjuvant chemotherapy (P = .02), and more often underwent robotic RC (P < .01). Major outpatient complications occurred in 18.1% of s-LOS patients vs 11.2% of r-LOS patients, and s-LOS was associated with a significant independent increase in the risk of major outpatient complications (hazard ratio 1.91, 95% confidence interval 1.03-3.56, P = .04). There was also a statistically significant association between s-LOS and readmission (hazard ratio 1.60, 95% confidence interval 1.01-2.44, P = .048).
  
  
  
  Early discharge post RC appears to be associated with an increased risk of major outpatient complications, suggesting that attempts to reduce LOS may need to be supplemented by additional outpatient services to diminish this effect. Further attention should be given to understanding how to better support patients discharged after a short LOS.
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Osawa
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Sapan N
authors.initials: SN
authors.lastname: Ambani
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Kola
authors.initials: K
authors.lastname: Olugbade
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Alon Z
authors.initials: AZ
authors.lastname: Weizer
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Montgomery
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Chang
authors.initials: C
authors.lastname: He
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Khaled S
authors.initials: KS
authors.lastname: Hafez
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Cheryl T
authors.initials: CT
authors.lastname: Lee
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Ganesh S
authors.initials: GS
authors.lastname: Palapattu
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI. Electronic address: tomorgan@med.umich.edu.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Morgan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D001749:Urinary Bladder Neoplasms / Q000601:surgery*