30-day Readmission After Radical Cystectomy: Identifying Targets for Improvement Using the Phases of Surgical Care

Overview

Journal Can Urol Assoc J

Specialty Urology

Date 2018 Nov 27

PMID 30472980

Citations 2

Authors

Ian Berger

Leilei Xia

Christopher Wirtalla

Phillip Dowzicky

Thomas J Guzzo

Rachel R Kelz

Affiliations

Soon will be listed here.

Abstract

Introduction: Postoperative readmissions following radical cystectomy (RC) have gained attention in the past decade. Postoperative and post-discharge complications play a role in readmission rates; however, our ability to predict readmissions remains poor.

Methods: Using the National Surgical Quality Improvement Program database, we identified patients with bladder cancer undergoing RC from 2013-2015. Complications were defined as postoperative and post-discharge. Outcomes were 30-day readmission, post-discharge complications, and post-discharge major complications. Patient, operative, and complication factors were assessed using multivariable logistic regression.

Results: We identified 4457 patients who underwent RC; 9.2% of patients experienced a postoperative complication, 18.8% experienced a post-discharge complication, and 20.3% were readmitted. Overweight and obese body mass index (BMI), dependent functional status, chronic obstructive pulmonary disease (COPD), a continent diversion, and duration of operation were associated with post-discharge complications. Postoperative complications were not associated with post-discharge complications. Readmission was associated with Black race (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.0-2.1), overweight (OR 1.5; 95% CI 1.2-1.8) and obese BMI (OR 1.5; 95% CI 1.2-1.9), diabetes (OR 1.2; 95% CI 1.0-1.5), COPD (OR 1.4; 95% CI 1.0-1.8), steroid use (OR 1.5; 95% CI 1.0-2.2), a continent diversion (OR 1.4; 95% CI 1.1-1.7), duration of operation (OR 1.1; 95% CI 1.1-1.2), and postoperative complications (OR 1.5; 95% CI 1.2-2.0). The majority of readmissions experienced a post-discharge complication.

Conclusions: Factors that span the preoperative, intraoperative, postoperative, and post-discharge phases of care were identified to increase readmission risk. To improve readmission rates, interventions will have to target factors across the surgical experience.

Citing Articles

Randomized Controlled Trial of Laparoscopic versus Open Radical Cystectomy in a Laparoscopic Naïve Center.

Fadlalla W, Hanafy A, Abdelhakim M, Aboulkassem H, Ashraf E, Abdelbary A Adv Urol. 2021; 2021:4731013.

PMID: 34306069 PMC: 8279872. DOI: 10.1155/2021/4731013.

The association between patient body mass index and perioperative outcomes following radical cystectomy: An analysis using the American College of Surgeons National Surgical Quality Improvement Program database.

Lenardis M, Harper B, Satkunasivam R, Klaassen Z, Wallis C Can Urol Assoc J. 2020; 14(9):E412-E417.

PMID: 32223872 PMC: 7492038. DOI: 10.5489/cuaj.6243.

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