A Model to Optimize Followup Care and Reduce Hospital Readmissions after Radical Cystectomy

Krishnan, Naveen; Liu, Xiang; Lavieri, Mariel S.; Hu, Michael S.; Helfand, Alexander M.; Li, Benjamin; Helm, Jonathan E.; He, Chang; Hollenbeck, Brent K.; Skolarus, Ted A.; Jacobs, Bruce L.

doi:10.1016/j.juro.2015.11.063

Cited by 26 publications

(23 citation statements)

References 21 publications

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“…In an administrative database analysis, James et al showed that 26% of cystectomy readmissions were considered modifiable 18 and Krishnan et al demonstrated that detection of at-risk patients could be improved with early clinician contact. 21 It is likely that even in the cases of some non-modifiable readmissions, earlier identification of at-risk patients would allow for prompt intervention and a reduction in the intensity of the overall readmission episode 16 as was evident by the multiple new diagnoses present in our cohort at the time of readmission.…”

Section: Discussionmentioning

confidence: 91%

“…Taken together, our findings demonstrate that the substantial burden of readmissions following cystectomy on patients, providers and hospital systems is not altered by whether someone has an open or robotic-assisted surgery. Therefore, efforts to reduce readmissions after cystectomy should likely focus on early communication after discharge, 20 prompt detection of clinical decompensation, and providing support during the first week after discharge, 21 rather than on the surgical approach itself.…”

Section: Discussionmentioning

confidence: 99%

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No Differences in Population-based Readmissions After Open and Robotic-assisted Radical Cystectomy: Implications for Post-discharge Care

Borza

Jacobs

Montgomery

et al. 2017

Urology

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Introduction Readmissions after radical cystectomy are common. Details regarding readmissions after robotic surgery are limited to institutional series. To inform whether readmission reduction strategies should consider surgical approach, we examined readmission differences between open and robotic-assisted radical cystectomy (RARC) using population-based data. Methods We identified patients who underwent cystectomy between January 2010 and September 2013 based on ICD-9 codes and administrative claims from a large, national US health insurer (Clinformatics™ Data Mart Database, OptumInsight, Eden Prairie, MN). We assessed post-discharge health system utilization and tested for differences in readmissions after the two surgical approaches. Results We identified 935 patients treated with cystectomy (785 (84%) open, 150 (16%) RARC). Patients undergoing RARC were slightly older, male, had more ileal conduit urinary reconstruction, and less need for intensive care. Index length of stay was shorter for RARC than for open surgery (7 days vs. 8 days, p<0.001). However, we found no differences in 30-day readmission rates (24% open vs. 29% RARC, p=0.26) or other readmission parameters including: readmission length of stay (5 days open vs. 4 days RARC, p=0.32), emergency department use (22% open vs. 24% RARC, p=0.86), reasons for readmission, or timing of first outpatient visits (11.5 days open vs. 9 days RARC, p=0.41). For both approaches, the majority of patients were readmitted within 2 weeks. Conclusions The surgical approach to cystectomy does not appear to impact readmissions. Strategies to reduce the readmission burden after cystectomy do not need to consider surgical approach, but should focus on timing of medical contacts

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

No Differences in Population-based Readmissions After Open and Robotic-assisted Radical Cystectomy: Implications for Post-discharge Care

Borza

Jacobs

Montgomery

et al. 2017

Urology

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“…These findings are important as interventions can be guided specifically to decrease readmissions in patients with a continent diversion. Krishnan et al modelled timing of office visits and telephone calls to prevent readmissions after RC. They showed that an office visit within 4–5 days followed by four telephone calls can maximally detect unplanned readmissions.…”

Section: Discussionmentioning

confidence: 99%

Hospitalisation and readmission costs after radical cystectomy in a nationally representative sample: does urinary reconstruction matter?

et al. 2018

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“…With our selected cutoff of LACE ≥ 10, 24% of patients fell within the high-risk category, a group that clearly demonstrated a higher rate of postoperative issues to which a targeted intervention could be employed. Krishnan et al [17] found that optimizing the timing of follow-up calls and appointments after radical cystec-tomy allowed for identification of concerning symptoms that may lead to readmission. Using the LACE score to identify patients for hospital-based and ambulatory interventions, as well as increased postoperative follow-up would be a reasonable investigative next-step at the institutional level.…”

Section: Discussionmentioning

confidence: 99%

The LACE Score as a Tool to Identify Radical Cystectomy Patients at Increased Risk of 90-Day Readmission and Mortality

Saluk¹,

Blackwell²,

Gange³

et al. 2018

Current Urology

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Introduction: Radical cystectomy for bladder cancer is associated with high rates of readmission. We investigated the LACE score, a validated prediction tool for readmission and mortality, in the radical cystectomy population. Materials & Methods: Patients who underwent radical cystectomy for bladder cancer were identified by ICD-9 codes from the Healthcare Cost and Utilization Project State Inpatient Database for California years 2007-2010. The LACE score was calculated as previously described, with components of L: length of stay, A: acuity of admission, C: comorbidity, and E: number of emergency department visits within 6 months preceding surgery. Results: Of 3,470 radical cystectomy patients, 638 (18.4%) experienced 90-day readmission, and 160 (4.6%) 90-day mortality. At a previously validated “high-risk” LACE score ≥ 10, patients experienced an increased risk of 90-day readmission (22.8 vs. 17.7%, p = 0.002) and mortality (9.1 vs. 3.5%, p < 0.001). On adjusted multivariable analysis, “high risk” patients by LACE score had increased 90-day odds of readmission (adjusted OR = 1.24, 95% CI: 0.99-1.54, p = 0.050) and mortality (adjusted OR = 2.09, 95% CI: 1.47-2.99, p < 0.001). Conclusion: The LACE score reasonably identifies patients at risk for 90-day mortality following radical cystectomy, but only poorly predicts readmission. Providers may use the LACE score to target high-risk patients for closer follow-up or intervention.

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A Model to Optimize Followup Care and Reduce Hospital Readmissions after Radical Cystectomy

Cited by 26 publications

References 21 publications

No Differences in Population-based Readmissions After Open and Robotic-assisted Radical Cystectomy: Implications for Post-discharge Care

No Differences in Population-based Readmissions After Open and Robotic-assisted Radical Cystectomy: Implications for Post-discharge Care

Hospitalisation and readmission costs after radical cystectomy in a nationally representative sample: does urinary reconstruction matter?

The LACE Score as a Tool to Identify Radical Cystectomy Patients at Increased Risk of 90-Day Readmission and Mortality

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