Geographic and clinical predictors of one-day discharge after radical prostatectomy: a SEER-Medicare cohort study

Objectives: To study the geographic patterns, temporal trends, and predictors of one-day discharge following radical prostatectomy. Methods: We conducted a retrospective cohort study of men diagnosed with prostate cancer from 2008 to 2019 in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Patients with metastatic disease, health maintenance organization coverage, or age younger than 66 years were excluded. Type of surgery and length of stay were derived from inpatient claims. We compared one-day discharge by early (2008–2013) and late (2014–2019) periods, by census region, and by individual- and facility-level factors, and used generalized estimating equations to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI), accounting for clustering of patients within hospitals. Results: Among 40,728 patients treated at 1,048 hospitals, 52.4% were discharged on postoperative day 1, increasing from 48.8% (2008–2013) to 56.8% (2014–2019). Higher odds of one-day discharge were associated with robotic surgery (aOR 2.88, 95% CI 2.54–3.27) and treatment at a National Cancer Institute-designated comprehensive cancer center (aOR 1.88, 95% CI 1.28–2.76). Black versus White patients (aOR 0.76, 95% CI 0.70–0.82), unmarried versus married patients (aOR 0.79, 95% CI 0.73–0.85), and patients in the lowest versus highest neighborhood socioeconomic quintile (aOR 0.86, 95% CI 0.79–0.94) had lower odds. Odds were 31% higher in the late versus early period (aOR 1.31, 95% CI 1.20–1.43). Regional differences were attenuated in sensitivity analyses. Conclusions: One-day discharge after radical prostatectomy has increased over time and is now the predominant practice among Medicare beneficiaries, driven primarily by robotic surgery and treatment era. Persistent racial and socioeconomic differences in discharge patterns warrant further research into whether early discharge is equally safe and beneficial across patient populations.