Day of RP affects complication rates, length of stay

San Diego-Radical prostatectomy performed on a Friday is associated with a higher complication rate and extended hospital stay compared with the same surgery performed on other days of the week.

In an examination of the Surveillance, Epidemiology, and End Results (SEER) linked database and the American Medical Association Physicians Masterfile (1995-2009), the adjusted 30-day and long-term complication rates were significantly higher and length of stay was significantly longer for surgeries on Friday compared with the reference group of cases that had prostatectomy performed on Monday through Thursday, reported Julian Hanske, MD, at the 2016 AUA annual meeting in San Diego. 

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“When you have a big database such as the SEER database, it enables you to do analyses to look at outcomes according to weekdays. While there is no difference in overall or cancer-specific survival, there are still differences during or after their hospital stay, within 30 or 90 days. These complications include urinary complications, urethral strictures or incontinence, or the other miscellaneous outcomes taken together, such as wound dehiscence and pulmonary complications,” said Dr. Hanske, research fellow at the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston and urology resident at Marien Hospital Herne, Ruhr-University Bochum, Germany.

Mark Preston, MD, MPH, of Brigham and Women’s Hospital, was the senior author of the study.

The study population consisted of 20,955 men diagnosed with prostate cancer who underwent prostatectomy within 1 year after diagnosis. There were 2,588 RPs performed on Fridays compared with more than 5,000 each on Mondays and Tuesdays, 4,151 on Wednesdays, and 3,570 on Thursdays. Yearly RP volume of the surgeon was lower on Fridays compared with other weekdays.

Next: Reduced complication risk seen on Mondays

Reduced complication risk seen on Mondays

In multivariable analyses adjusting for age at diagnosis, ethnicity, marital status, income, level of education, residence, Charlson Comorbidity Index (CCI), year of surgery, RP type, tumor pathologic stage, tumor grade, surgeon age, yearly RP volume, and weekday clustered by health service area, RP performed on Mondays was associated with reduced risks of 30-day complications (OR=0.89; 95% CI: 0.83-0.96) and long-term urinary complications (HR=0.93; 95% CI: 0.87-0.99).

In contrast, RP performed on Fridays was associated with higher complication rates (OR=1.12; 95% CI: 1.02-1.23) and a higher rate of hospital stay longer than 2 days (OR=1.19; 95% CI: 1.08-1.32).

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The day of surgery had no significant effect on overall or cancer-specific mortality.

According to Dr. Hanske, it’s possible that less experienced attendings are performing RP on Fridays. Nevertheless, “We shouldn’t think about the attending,” he told Urology Times. “We should think about the patient and think of doing less high-risk procedures at the end of the week. If there’s a patient who’s sicker, has a higher symptom score or higher CCI, maybe he’s a better patient to have on Monday or Tuesday.”

More on Prostate Cancer:

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