Early and Late Perioperative Outcomes Following Radical Cystectomy: 90-Day Readmissions, Morbidity and Mortality in a Contemporary Series

Stimson, C.J.; Chang, Sam S.; Barocas, Daniel A.; Humphrey, J. A. C.; Patel, Sanjay G.; Clark, Peter E.; Smith, Joseph A.; Cookson, Michael S.

doi:10.1016/j.juro.2010.06.007

Cited by 225 publications

(156 citation statements)

References 18 publications

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“…We confirmed the morbidity revealing a 22.8% readmission, 55.2% complication, and 2.3% in-hospital mortality rate, which is similar to other published series. [7][8][9]13,14 We also revealed that treatment at higher-volume centres or academic centres was not protective or predictive of readmission. Academic centres were less likely to discharge patients to PACFs, which may be protective.…”

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confidence: 69%

“…Radical cystectomy (RC) may face scrutiny since it is associated with complication rates up to 68% and readmission rates as high as 26% even when performed at centres of excellence. [7][8][9] Given this data, RC could be a target quality improvement area. Therefore, our objective was to determine patient-and provider-related factors associated with 30-day readmission after RC.…”

Section: Introductionmentioning

confidence: 98%

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Few modifiable factors predict readmission following radical cystectomy

Minnillo

Maurice

Schiltz

et al. 2015

CUAJ

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Introduction: We sought to determine the patient and providerrelated factors associated with readmission after radical cystectomy (RC) for bladder cancer. In this era of healthcare reform, hospital performance measures, such as readmission, are beginning to affect provider reimbursement. Given its high readmission rate, RC could be a target for quality improvement. Methods: We reviewed bladder cancer patients who underwent RC in California's State Inpatient Database (2005Database ( -2009) of the Healthcare Cost and Utilization Project. We examined patient-(e.g., race, discharge disposition) and provider-related factors (e.g., volume) and evaluated their association with 30-day readmission. Multivariable logistic regression was used to examine associations of interest. Results: Overall, 22.8% (n = 833) of the 3649 patients who underwent RC were readmitted within 30 days. Regarding disposition, 34.8%, 50.8%, and 12.2% were discharged home, home with home healthcare, and to a post-acute care facility (PACF), respectively. Within 30 days, 20.3%, 20.9%, and 42.3% were discharged home, home with home healthcare, and to a PACF were readmitted, respectively. African Americans (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.07-2.50), having ≥2 comorbidities (OR 1.42, 95% CI 1.06-1.91), receiving a neobladder (OR 1.45, 95% CI 1.09-1.93), and discharged to a PACF (OR 3.79, 95% CI 2.88-4.98) were independent factors associated with readmission. Hospital stays ≥15 days were associated with less readmission (OR 0.43, p = 0.0002). Procedure volume was not associated with complication, in-hospital mortality, or readmission. Conclusions: About one-fifth of patients undergoing RC are readmitted. Patients who are discharged to a PACF, African American, and who have more extensive comorbidities tend to experience more readmissions. Increased efforts with care coordination among these patients may help reduce readmissions.

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confidence: 69%

Section: Introductionmentioning

confidence: 98%

Few modifiable factors predict readmission following radical cystectomy

Minnillo

Maurice

Schiltz

et al. 2015

CUAJ

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“…Patient and hospital-level characteristics of index readmitted, non-index readmitted, and all cystectomy patients. 4 [3,7] 4 [3,8] 4 [3,7] Mean Number of Readmissions during 90-day follow-up (SE) Table 3 Causes of index and non-index readmission using principal ICD-9 diagnosis code. …”

Section: Discussionmentioning

confidence: 99%

Causes, Timing, Hospital Costs and Perioperative Outcomes of Index vs Nonindex Hospital Readmissions after Radical Cystectomy: Implications for Regionalization of Care

et al. 2017

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Purpose-To compare the timing, causes, hospital costs, and perioperative outcomes of index vs. non-index hospital readmissions following radical cystectomy.Materials and Methods-The 2013 Nationwide Readmissions Database was queried for bladder cancer patients undergoing cystectomy. Sociodemographic characteristics, hospital costs, and causes of readmission were compared among index and non-index readmitted patients. Univariable and multivariable logistic regression models were used to identify predictors of nonindex readmissions, mortality during the first readmission, and subsequent readmission.Results-Among 4991 patients identified, 29%(1447/4991) and 11%(571/4991) experienced an index and non-index readmission, respectively. Compared to index readmissions, non-index readmissions were more likely late readmissions (p<0.001) of older patients (p=0.047) that had cystectomies at higher volume hospitals (p=0.02) and were readmitted to hospitals located in less populated areas (p<0.001). Compared to index readmissions, the percentage of non-index readmissions for cardiovascular complications was higher (7.6% vs. 2.9%, p=0.003) while the percentage of non-index readmissions for gastrointestinal (6.0% vs. 11.0%, p=0.04) Disclosures: NonePublisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptConclusions-This nationally representative study of cystectomy patients demonstrated comparable perioperative outcomes and hospital costs between index and non-index readmitted RC patients, which supports the continued regionalization of cystectomy care.

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“…1 Despite refinements in surgical technique and perioperative management, RC has been associated with a substantial risk of postoperative morbidity and mortality, where the rates of short-term complications and mortality. [1][2][3][4][5][6][7] Identifying determinants of postoperative outcomes is crucial for individual risk-adjustment prior to RC. Several studies have reported predictors of complications, perioperative mortality, and readmission.…”

Section: Introductionmentioning

confidence: 99%

Short-term perioperative outcomes of patients treated with radical cystectomy for bladder cancer included in the National Surgical Quality Improvement Program (NSQIP) database

Gandaglia

Varda

Sood

et al. 2014

CUAJ

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Introduction: We report the contemporary outcomes of radical cystectomy (RC) in patients with bladder cancer using a national, prospective perioperative database specifically developed to assess the quality of surgical care. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2006 to 2011 for RC. Data on postoperative complications, operative time, length of stay, blood transfusions, readmission, and mortality within 30 days from surgery were abstracted. Results: Overall, 1094 patients undergoing RC were identified. Rates of overall complications, transfusions, prolonged length of hospitalization, readmission, and perioperative mortality were 31.1%, 34.4%, 25.9%, 20.2%, and 2.7%, respectively. Body mass index represented an independent predictor of overall complications on multivariate analysis (p = 0.04). Baseline comorbidity status was associated with increased odds of postoperative complications, prolonged operative time, transfusion, prolonged hospitalization, and perioperative mortality. In particular, patients with cardiovascular comorbidities were 2.4 times more likely to die within 30 days following cystectomy compared to their healthier counterparts (p = 0.04). Men had lower odds of prolonged operative time and blood transfusions (p ≤ 0.03). Finally, the receipt of a continent urinary diversion was the only predictor of readmission (p = 0.02). Our results are limited by their retrospective nature and by the lack of adjustment for hospital and tumour volume. Conclusions: Complications, transfusions, readmission, and perioperative mortality remain relatively common events in patients undergoing RC for bladder cancer. In an era where many advocate the need for prospective multi-institutional data collection as a means of improving quality of care, our study provides data on short-term outcomes after RC from a national quality improvement initiative.

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Early and Late Perioperative Outcomes Following Radical Cystectomy: 90-Day Readmissions, Morbidity and Mortality in a Contemporary Series

Cited by 225 publications

References 18 publications

Few modifiable factors predict readmission following radical cystectomy

Few modifiable factors predict readmission following radical cystectomy

Causes, Timing, Hospital Costs and Perioperative Outcomes of Index vs Nonindex Hospital Readmissions after Radical Cystectomy: Implications for Regionalization of Care

Short-term perioperative outcomes of patients treated with radical cystectomy for bladder cancer included in the National Surgical Quality Improvement Program (NSQIP) database

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