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McConnell JD, Barry MJ, Bruskewitz RC. Benign Prostatic Hyperplasia: Diagnosis and Treatment. Rockville (MD): Agency for Health Care Policy and Research (AHCPR); 1994 Feb. (AHCPR Clinical Practice Guidelines, No. 8.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Benign Prostatic Hyperplasia: Diagnosis and Treatment

Benign Prostatic Hyperplasia: Diagnosis and Treatment.

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17 Hospital Stay, Recovery Time, Loss of Work Time

Hospital stay, recovery time, and loss of work time directly or indirectly affect the cost of an intervention. The estimates for hospital stay presented in the Balance Sheet (Attachment B) reflect evidence from the scientific literature and data from the Health Care Financing Administration (HCFA) Medicare data base, as well as subjective adjustments made to both sets of data based on the expert opinion of the panel members. The final estimates given in the Balance Sheet, both for hospital stay and for loss of work time, are based on the expert opinion of the panel. This is because the data on hospital stay even from recent studies are not a true reflection of current practice. For example, TUIP is now an outpatient or 1-day inpatient procedure. The length of TURP hospital stays has decreased significantly, and some TURPs are done in outpatient settings.

Hospital Stay

Patients treated by watchful waiting, alpha blockers, or finasteride of course do not require hospitalization at all (0 days). Balloon dilation is usually performed as an outpatient procedure or as a same-day-admission, overnight-stay procedure. Although the average hospital stay for balloon dilation may be less than a day, the panel estimated a full day's hospital stay for the Balance Sheet because even a day-surgery procedure requires the patient to spend the better part of 1 day at the hospital. For both transurethral procedures (TUIP and TURP) and for open surgery, data on hospital stay are available in a number of studies. Table 27 summarizes the information.

Table 27. Number of patients reported in published studies, average hospital stay, shortest and longest reported average hospital stay, by type of treatment.

Table

Table 27. Number of patients reported in published studies, average hospital stay, shortest and longest reported average hospital stay, by type of treatment.

Caveats apply to the data presented in Table 27. For one, the data on open surgery are based on studies published between 1954 and 1985, most before 1979 when hospital stays were generally longer. The data based on TUIP studies (1984-89) and TURP studies (1973-88) tend to reflect a different era in medicine, with a different philosophy concerning hospitalization and a more aggressive approach to early discharge.

Other caveats apply as well. Most of the studies originate from major academic institutions and VA hospitals and do not necessarily reflect length of stay in a private practice setting. Furthermore, most studies report average or mean hospital stay, rather than median stay. In any cohort of several hundred patients, some will undoubtedly have a major complication requiring very prolonged hospital stay, by contrast with the likely majority of patients who do not have such complications. The mean, which tends to be affected by extreme data values, will incorrectly indicate a longer hospital stay than is true for the majority of the patients. The median stay (50 percent of the patients stayed shorter or longer than this number of days) would represent a more accurate reflection of the most likely hospital stay for any given patient, but the data are rarely reported in this way. Information on median stay can be obtained, however, from sources such as the HCFA data base, which reflects Medicare patient data.

The data in Table 28, from the HCFA data base, represent fiscal year 1989. The table makes evident that (1) the mean stay for these Medicare patients in the HCFA data base is very similar to the average stay for patients in the BPH panel's literature-derived data base (Table 27) for retropubic and suprapubic open prostatectomies and for TURP and that (2) the median stay is shorter for all interventions by approximately 2 days.

Table 28. Hospital stay for Medicare patients (1989).

Table

Table 28. Hospital stay for Medicare patients (1989).

After fiscal year 1989, several changes took place that most likely affect the length of hospitalization further: (1) The Diagnosis Related Group (DRG) system effectively reduced hospitalization by shortening the overall stay after a given procedure; (2) same-day admissions became increasingly popular for elective surgery such as prostatectomy; and (3) with the use of local anesthesia, TUIP and TURP have been performed on a day-surgery basis.

In summary, the number of days stated in the Balance Sheet (Attachment B) reflects (1) the evidence found in the scientific literature, (2) data from the HCFA data base on Medicare patients, and (3) subjective adjustments made to both sets of data based on the expert opinion of the panel.

Loss of Work Time

Work requiring an intermediate level of physical activity was assumed for the purpose of estimating the loss of work time. Loss of work time was calculated for the first year after treatment. It therefore reflects hospital stay, recovery time at home, and followup office visits. Each office visit equals one-half day's loss of work time due to travel, waiting time, and similar factors. These data are based on the panel's subjective opinion.

Patients under a watchful waiting regimen would generally be seen at most only twice a year (equaling 1 day), whereas patients treated by alpha blockers have to be seen more often in the first year for the titration phase of the treatment (totaling 3.5 days). Balloon dilation is most often performed as an outpatient or a day-surgery procedure (equaling 1 day), but patients usually must stay at home for about 2 days following the procedure. Two more office visits may be needed during the first year, bringing the total to 4 days.

Both transurethral surgical techniques (TUIP and TURP) require recovery at home before the patient can go back to work. The panel assumed a loss of work time between 7 and 21 days, depending on the associated conditions and the extent of the intervention/resection. Open surgery patients are generally advised to postpone physical activity for about 4 weeks. Depending on the profession, work may be resumed earlier. The panel estimated 21 to 28 days' loss of work time.

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