HOSPITAL OUTCOMES AND HEALTHCARE BURDEN OF TESTICULAR CANCER: A RETROSPECTIVE ANALYSIS OF THE 2024 NATIONAL INPATIENT SAMPLE

Abstract

Introduction

Testicular cancer, although relatively rare, is the most common malignancy in young men aged 15 to 35 years. It accounts for approximately 1% of all male cancers but has a high survival rate if detected early. Testicular cancer can have significant implications for fertility and quality of life, making it a critical area of focus for public health and clinical research. Despite advancements in treatment, disparities in outcomes exist based on various demographic and hospital-related factors. This study aims to estimate the prevalence, mortality rate, hospital length of stay (LOS), and total hospitalization charges for patients with testicular cancer using the National Inpatient Sample (NIS) data from 2021.

Methods

We conducted a retrospective analysis using the NIS dataset, which included 6,666,752 observations. Testicular cancer cases were identified using the appropriate ICD-10 code. Survey procedures (svy) were utilized to account for the complex survey design of the NIS. The primary outcome of interest was in-hospital mortality, while secondary outcomes included hospital length of stay (LOS) and total hospitalization charges (TOTCHG). Descriptive statistics and regression analyses were performed to examine the associations between testicular cancer and these outcomes. Independent variables included age, gender, race, zip code income quartile, Charlson Comorbidity Index, weekend admission, hospital region, teaching status, and bed size.

Results

The total number of testicular cancer cases was estimated to be 8,225 (95% CI: 7,434 - 9,016). The crude total of in-hospital deaths among testicular cancer patients was 265 (95% CI: 192 - 338), resulting in a mortality rate of 3.22% (95% CI: 2.45% - 4.23%). Adjusted logistic regression analysis revealed significant associations with the Charlson Comorbidity Index (Odds Ratio [OR] = 1.390, p < 0.001) and hospital teaching status (OR = 0.468, p = 0.043), while patients identified as Asian/Pacific Islander had a significantly higher odds ratio (OR = 6.210, p = 0.004).

The mean LOS for testicular cancer patients was 6.44 days (95% CI: 6.07 - 6.82). Adjusted linear regression analysis showed that LOS was significantly associated with patients identified as Native American (Coefficient = 14.039, p = 0.041) and Charlson Comorbidity Index (Coefficient = 0.590, p < 0.001). The mean total hospitalization charges for testicular cancer patients were $88,194 (95% CI: $80,853 - $95,536). Adjusted regression analysis identified significant associations with Charlson Comorbidity Index (Coefficient = $8,633, p < 0.001), hospital region, teaching status (Coefficient = $19,921, p = 0.006), and hospital bed size (Coefficient for the largest bed size category = $19,562, p = 0.009).

Conclusions

This study highlights the significant burden of testicular cancer in hospitalized patients, with notable associations between mortality, length of stay, and hospitalization charges with various demographic and hospital-related factors. Higher Charlson Comorbidity Index and specific racial categories were linked to higher mortality rates, while higher Charlson Comorbidity Index and specific racial categories were associated with longer hospital stays. Total hospitalization charges were influenced by comorbidity index, hospital region, teaching status, and bed size. These findings underscore the need for targeted healthcare strategies to improve outcomes for testicular cancer patients, taking into account the identified demographic and hospital-related factors.