Characterising ‘bounce‐back’ readmissions after radical cystectomy

Abstract

ObjectiveTo examine predictors of early readmissions after radical cystectomy (RC). Factors associated with preventable readmissions may be most evident in readmissions that occur within 3 days of discharge, commonly termed 'bounce-back' readmissions, and identifying such factors may inform efforts to reduce surgical readmissions. Patients and MethodsWe utilised the Healthcare Cost and Utilization Project's State Inpatient Databases to examine 1867 patients undergoing RC in 2009 and 2010, and identified all patients readmitted within 30 days of discharge. We assessed differences between patients experiencing bounce-back readmission compared to those readmitted 8-30 days after discharge using logistic regression models and also calculated abbreviated LACE scores to assess the utility of common readmissions risk stratification algorithms. ResultsThe 30-day and bounce-back readmission rates were 28.4% and 5.6%, respectively. Although no patient or index hospitalisation characteristics were significantly associated with bounce-back readmissions in adjusted analyses, bounceback patients did have higher rates of gastrointestinal (14.3% vs 6.7%, P = 0.02) and wound (9.5% vs 3.0%, P < 0.01) diagnoses, as well as increased index and readmission length of stay (5 vs 4 days, P = 0.01). Overall, the median abbreviated LACE score was 7, which fell into the moderate readmission risk category, and no difference was observed between readmitted and non-readmitted patients. ConclusionOne in five readmissions after RC occurs within 3 days of initial discharge, probably due to factors present at discharge. However, sociodemographic and clinical factors, as well as traditional readmission risk tools were not predictive of this bounce-back. Effective strategies to reduce bounce-back readmission must identify actionable clinical factors prior to discharge.

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

“…Hospital readmission was required in seven patients (11.7%; 2 from the LRC and 5 from the ORC groups, respectively, P =0.42). This was in line with other studies which reported a relatively high readmission rate of 8.6–28% after radical cystectomy [ 25 , 26 ]. In a large cohort of 8827 Medicare patients, there was no difference in rates of hospital readmissions between minimally invasive and open radical cystectomy, which suggests that the high readmission rates are inherent to radical cystectomy itself regardless of the approach [ 27 ].…”

Classification of Post-Pancreatectomy Readmissions and Opportunities for Targeted Mitigation Strategies

“…All readmissions within 90 days of an operation were analyzed for primary indication, complications, and interventions. Readmissions within 3 days of discharge were classified as early readmissions consistent with readmission literature 22 . The primary reason for readmission was classified, in order of priority, as technical (pancreatic or nonpancreatic anastomotic leak), infectious (surgical site or other infections not resulting from a technical complication), or medical/metabolic (DGE, failure to thrive, poor oral intake, or another medical problem not resulting from a technical or infectious cause).…”

Patient, Physician, Hospital Factors Associated With Readmission After Radical Cystectomy

“…Reasons for readmission can include failure to thrive, wound or pelvic infection, venous thromboembolism, or small-bowel obstruction. 3,4 Readmission not only is associated with increased risks for the patient from a clinical standpoint, but also can have a significant cost burden on the health care system. 5,6 Several studies have identified clinical or patient risk factors associated with readmission after RC.…”