Trends in Outpatient Radical Prostatectomy and Same-Day Discharge for Prostate Cancer: Analysis of the National Inpatient Sample and Nationwide Ambulatory Surgery Sample.

Abstract

Introduction: Interest has grown in optimizing radical prostatectomy (RP) pathways for prostate cancer, and RP has been removed from the Centers for Medicare & Medicaid Services inpatient-only list. We aim to determine national trends in outpatient RP.

Methods: The National Inpatient Survey and Nationwide Ambulatory Surgery Survey were queried to categorize RPs between 2016 and 2020 as inpatient RP and outpatient RPs, comprising same-day discharge (SDD) and ambulatory encounters. Trends in outpatient RP over time were analyzed. Multivariable logistic regression analysis identified factors associated with SDD. Multivariable generalized linear models were used to compare total hospital charges between SDD and inpatient RPs.

Results: In a cohort of 362,123 RPs from 2016 to 2020, outpatient RPs increased from 4.8% to 53.7% (P < .01) and SDD increased from 0.03% to 2.0% (P < .01). Minimally invasive surgery (OR, 1.59, P < .01), highest quartile annual hospital caseload (OR, 1.98, P = .01), and low hospital bed count (OR, 1.96, P = .03) were associated with SDD. Less than 20% of centers used SDD, although a select few hospitals discharged more than 50% of RPs the same day. Ambulatory ($63,060) and SDD ($63,332) RPs had lower total charges compared with inpatient RPs ($69,951). Multivariable analysis demonstrated that SDD was associated with a reduction in total charges (OR, 0.88, P < .01).

Conclusions: Over 50% of RPs are now performed as ambulatory or SDD encounters. SDD RP is more common in high-volume facilities with lower bed counts. Although our data suggest lower hospital charges, further study is warranted to evaluate the impact of SDD on readmission rates and direct patient costs.