Introduction: Discharge to home is a measurable patient outcome used to assess quality of care for hospitals. The 2021 US news and world report (USNWR) uses this metric to rate patient outcomes when calculating Urology hospital rankings. Our objective was to identify patient risk factors that predict non-home discharge after surgery for urologic malignancies.
Methods: The ACS-NSQIP database was queried using urology specific Current Procedural Terminology (CPT) codes to retrospectively identify patients who had undergone open, laparoscopic, or robotic surgery for urologic malignancies including prostate, bladder, kidney, or upper tract urothelial cancer from 2011-2019. Descriptive statistics were used to compare patients who were discharged to home versus non-home discharges. Univariable and multivariable logistic regression analysis were performed to identify patient characteristics that were associated with non-home discharges. All tests were two-sided and statistical significance was considered when p<0.05.
Results: Non-home discharge occurred in 3.03% of the 103,244 patients in our study. In our study population 91.7% were male while 8.3% were female. Women were more likely to have non-home discharges (male:female OR 0.62 p<0.0001). As expected, non-home discharge was more common in patients who underwent cystectomy when compared to nephrectomy (OR 1.51 p=0.016) or prostatectomy (OR 1.56 p=0.002). Those with elevated BMI were less likely to experience non-home discharge (OR 0.85 p=0.002) while patients who were identified as underweight and those with unexpected weight loss prior to surgery were more likely to have non-home discharges (OR 1.90 p<0.0001, OR 2.02, p<0.0001). Comorbidities including diabetes and cardiopulmonary disease were also found to be significant independent predictors of non-home discharges.
Conclusions: Patient factors including age, gender, weight, comorbidities, and site of procedure were found to be independent predictors of non-home discharge following surgery for urologic malignancies. Patients with these risk factors should be counseled pre-operatively on the likelihood of requiring a non-home discharge to help manage expectations and create a standardized transition of care pathway following surgery.