Use of Routine Home Health Care and Deviations From an Uncomplicated Recovery Pathway After Radical Prostatectomy

Urology. 2018 Feb;112:74-79. doi: 10.1016/j.urology.2017.11.004. Epub 2017 Nov 16.

Abstract

Objective: To evaluate the statistical association between routine home health use after prostatectomy, short-term surgical outcomes, and payments.

Methods: We identified all men who underwent a robotic radical prostatectomy from April 1, 2014, to October 31, 2015, in the Michigan Urological Surgery Improvement Collaborative (MUSIC) with insurance from Medicare or a large commercial payer. We calculated rates of "routine" home care use after prostatectomy by urology practice. We defined "routine" home care as home care initiated within 4 days of discharge among patients discharged without a pelvic drain. We then compared emergency department (ED) visits, readmissions, prolonged catheter use, catheter reinsertion rates, and 90-day episode payments, in unadjusted and using a propensity-adjusted analysis, for those who did and did not receive home care.

Results: We identified 647 patients, of whom 13% received routine home health care. At the practice level, the use of routine home care after prostatectomy varied from 0% to 53% (P = .05) (mean: 3.6%, median: 0%). Unadjusted, patients with routine home care had increased ED visits within 16 days (15.5% vs 6.9%, P <.01), similar rates of catheter duration for >16 days (3.6% vs 3.0%, P = .79) and need for catheter replacement (1.2% vs 2.5%, P = .46), and a trend toward decreased readmissions (0% vs 4.1%, P = .06). Only the increased ED visits remained significant in adjusted analyses (P <.01). Home health had an average payment of $1000 per episode.

Conclusion: Thirteen percent of patients received routine home health care after prostatectomy, without improved outcomes. These findings suggest that patients do not routinely require home health care to improve short-term outcomes following radical prostatectomy, however, the appropriate use of home health care should be evaluated further.

MeSH terms

  • Aftercare* / economics
  • Aftercare* / statistics & numerical data
  • Critical Pathways
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / statistics & numerical data
  • Home Care Services* / economics
  • Home Care Services* / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Prostatectomy* / methods
  • Prostatic Neoplasms / surgery*
  • Treatment Outcome