Contemporary rates and predictors of prolonged hospital stay after radical cystectomy: a population-based analysis

doi:10.1007/s00345-025-05860-6

. 2025 Aug 8;43(1):478.

doi: 10.1007/s00345-025-05860-6.

Contemporary rates and predictors of prolonged hospital stay after radical cystectomy: a population-based analysis

Natali Rodriguez Peñaranda^{1

2}, Fabian Falkenbach^{3

4}, Andrea Marmiroli^{3

5

6}, Mattia Longoni^{3

7

8}, Quynh Chi Le^{3

9}, Calogero Catanzaro^{3

10}, Michele Nicolazzini^{3

11

12}, Francesco Di Bello^{3

13}, Jordan A Goyal³, Fred Saad³, Shahrokh F Shariat^{14

15

16

17}, Gennaro Musi^{5

18}, Markus Graefen⁴, Alberto Briganti⁷, Felix K H Chun⁹, Riccardo Schiavina¹⁰, Alessandro Volpe¹¹, Stefano Resca¹⁹, Ivan Matteo Tavolini²⁰, Stefano Puliatti¹⁹, Salvatore Micali¹⁹, Pierre I Karakiewicz³

Affiliations

¹ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. natalirodriguez647@gmail.com.
² Department of Urology, AOU di Modena, University of Modena and Reggio Emilia, Via Pietro Giardini, 1355, 41126, Baggiovara, Italy. natalirodriguez647@gmail.com.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁴ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁵ Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
⁶ Università degli Studi di Milano, Milan, Italy.
⁷ Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
⁸ Vita-Salute San Raffaele University, Milan, Italy.
⁹ Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany.
¹⁰ Department of Urology, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy.
¹¹ Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
¹² Division of Urology, Department of Oncology, University of Turin, Orbassano, Italy.
¹³ Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
¹⁴ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
¹⁵ Department of Urology, Weill Cornell Medical College, New York, NY, USA.
¹⁶ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁷ Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
¹⁸ Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy.
¹⁹ Department of Urology, AOU di Modena, University of Modena and Reggio Emilia, Via Pietro Giardini, 1355, 41126, Baggiovara, Italy.
²⁰ IGG Italian Germ Cell Cancer Group, Genova, Italy.

PMID: 40778945
DOI: 10.1007/s00345-025-05860-6

Contemporary rates and predictors of prolonged hospital stay after radical cystectomy: a population-based analysis

Natali Rodriguez Peñaranda et al. World J Urol. 2025.

. 2025 Aug 8;43(1):478.

doi: 10.1007/s00345-025-05860-6.

Authors

Affiliations

¹ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. natalirodriguez647@gmail.com.
² Department of Urology, AOU di Modena, University of Modena and Reggio Emilia, Via Pietro Giardini, 1355, 41126, Baggiovara, Italy. natalirodriguez647@gmail.com.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁴ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁵ Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
⁶ Università degli Studi di Milano, Milan, Italy.
⁷ Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
⁸ Vita-Salute San Raffaele University, Milan, Italy.
⁹ Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany.
¹⁰ Department of Urology, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy.
¹¹ Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
¹² Division of Urology, Department of Oncology, University of Turin, Orbassano, Italy.
¹³ Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
¹⁴ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
¹⁵ Department of Urology, Weill Cornell Medical College, New York, NY, USA.
¹⁶ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁷ Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
¹⁸ Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy.
¹⁹ Department of Urology, AOU di Modena, University of Modena and Reggio Emilia, Via Pietro Giardini, 1355, 41126, Baggiovara, Italy.
²⁰ IGG Italian Germ Cell Cancer Group, Genova, Italy.

PMID: 40778945
DOI: 10.1007/s00345-025-05860-6

Abstract

Objective: To test contemporary rates and predictors of prolonged hospital stay after radical cystectomy (RC) and ileal conduit in non-metastatic bladder cancer patients.

Methods: Within the National Inpatient Sample database (NIS, 2008-2019), we identified ileal conduit RC patients and tabulated length of stay (LOS) ≥ 75th percentile vs. others. Temporal trends and multivariable logistic regression models (LRM) were fitted.

Results: Of 10,934 patients, 3,116 (28%) exhibited LOS ≥ 75th percentile (≥ 10 days), with rates decreasing from 35.4% in 2008 to 20.0% in 2019 (p < 0.001). In multivariable LRM, independent predictors of LOS ≥ 75th percentile were age ≥ 80 years (OR 1.37), CCI ≥ 2 (OR 1.55), coagulopathy (OR 1.55), obesity (OR 1.15), African American race/ethnicity (OR 1.57), female sex (OR 1.17), Medicare (OR 1.24) or Medicaid (OR 1.41) insurance, and treatment at low- (OR 1.68) or medium-volume hospitals (OR 1.33). Conversely, minimally invasive surgery (OR 0.59) exhibited the opposite protective effect (all p ≤ 0.03). Interestingly, the combined effect of age (≥ 80 vs. < 80 years) and surgical approach (minimally invasive vs. open) also achieved independent predictive status. Specifically, patients aged ≥ 80 undergoing minimally invasive, < 80 undergoing open, and ≥ 80 undergoing open surgery were, respectively, 1.35, 1.65, and 2.29 times more likely to require LOS ≥ 75th percentile compared to those aged < 80 undergoing minimally invasive surgery (all p ≤ 0.004).

Conclusion: The proportion requiring LOS ≥ 75th percentile decreased over time. Multivariable LRMs showed that age, race, insurance, hospital characteristics, and surgical approach were significantly associated with LOS ≥ 75th percentile. Combinations of variables, such as age ≥ 80 and open surgery, identified higher-risk subgroups.

Keywords: Age; Cystectomy; Ileal conduit; LOS; Minimally invasive surgery; Predictors.

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Conflict of interest statement

Declarations. Conflicts of Interest: The authors declare no competing interests. Ethical approval: Not applicable. Consent to participate: Not applicable.

References

1. Brasel KJ, Lim HJ, Nirula R, Weigelt JA (2007) Length of stay: an appropriate quality measure? Arch Surg 142(5):461–466. https://doi.org/10.1001/archsurg.142.5.461 - DOI - PubMed
1. Moore L et al (2014) Derivation and validation of a quality indicator of acute care length of stay to evaluate trauma care. Ann Surg 260(6):1121–1127. https://doi.org/10.1097/SLA.0000000000000648 - DOI - PubMed
1. Bream MJ, Maurice MJ, Altschuler J, Zhu H, Abouassaly R (2017) Increased use of cystectomy in patients 75 and older: a contemporary analysis of survival and perioperative outcomes from the National Cancer Database. Urology 100:72–78. https://doi.org/10.1016/j.urology.2016.08.054 - DOI - PubMed
1. Froehner M et al (2018) Predicting 90-day and long-term mortality in octogenarians undergoing radical cystectomy. BMC Urol 18(1):91. https://doi.org/10.1186/s12894-018-0402-z - DOI - PubMed - PMC
1. Siddiqui KM, Izawa JI (2016) Ileal conduit: standard urinary diversion for elderly patients undergoing radical cystectomy. World J Urol 34(1):19–24. https://doi.org/10.1007/s00345-015-1706-1 - DOI - PubMed

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[1] Brasel KJ, Lim HJ, Nirula R, Weigelt JA (2007) Length of stay: an appropriate quality measure? Arch Surg 142(5):461–466. https://doi.org/10.1001/archsurg.142.5.461 - DOI - PubMed

[2] Brasel KJ, Lim HJ, Nirula R, Weigelt JA (2007) Length of stay: an appropriate quality measure? Arch Surg 142(5):461–466. https://doi.org/10.1001/archsurg.142.5.461 - DOI - PubMed

[3] Moore L et al (2014) Derivation and validation of a quality indicator of acute care length of stay to evaluate trauma care. Ann Surg 260(6):1121–1127. https://doi.org/10.1097/SLA.0000000000000648 - DOI - PubMed

[4] Moore L et al (2014) Derivation and validation of a quality indicator of acute care length of stay to evaluate trauma care. Ann Surg 260(6):1121–1127. https://doi.org/10.1097/SLA.0000000000000648 - DOI - PubMed

[5] Bream MJ, Maurice MJ, Altschuler J, Zhu H, Abouassaly R (2017) Increased use of cystectomy in patients 75 and older: a contemporary analysis of survival and perioperative outcomes from the National Cancer Database. Urology 100:72–78. https://doi.org/10.1016/j.urology.2016.08.054 - DOI - PubMed

[6] Bream MJ, Maurice MJ, Altschuler J, Zhu H, Abouassaly R (2017) Increased use of cystectomy in patients 75 and older: a contemporary analysis of survival and perioperative outcomes from the National Cancer Database. Urology 100:72–78. https://doi.org/10.1016/j.urology.2016.08.054 - DOI - PubMed

[7] Froehner M et al (2018) Predicting 90-day and long-term mortality in octogenarians undergoing radical cystectomy. BMC Urol 18(1):91. https://doi.org/10.1186/s12894-018-0402-z - DOI - PubMed - PMC

[8] Froehner M et al (2018) Predicting 90-day and long-term mortality in octogenarians undergoing radical cystectomy. BMC Urol 18(1):91. https://doi.org/10.1186/s12894-018-0402-z - DOI - PubMed - PMC

[9] Siddiqui KM, Izawa JI (2016) Ileal conduit: standard urinary diversion for elderly patients undergoing radical cystectomy. World J Urol 34(1):19–24. https://doi.org/10.1007/s00345-015-1706-1 - DOI - PubMed

[10] Siddiqui KM, Izawa JI (2016) Ileal conduit: standard urinary diversion for elderly patients undergoing radical cystectomy. World J Urol 34(1):19–24. https://doi.org/10.1007/s00345-015-1706-1 - DOI - PubMed

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Contemporary rates and predictors of prolonged hospital stay after radical cystectomy: a population-based analysis

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Contemporary rates and predictors of prolonged hospital stay after radical cystectomy: a population-based analysis

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