Few modifiable factors predict readmission following radical cystectomy

Abstract

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.

Characterising ‘bounce‐back’ readmissions after radical cystectomy

“…However, prior work suggests that targetable and mutable factors driving readmission after RC are elusive. It may be the case that very early readmissions are largely unmodifiable, consistent with existing findings across the full 30-day readmission time frame [12,13].…”

Postoperative Rehabilitation May Reduce the Risk of Readmission After Groin Hernia Repair

“…Recent studies have emphasized the importance of post-acute care after surgery 11 , 19 – 27 , which we found may prevent short-term readmission. Our findings contradict previous studies showing an elevated risk of readmission in patients discharged to poste-acute care facilities after surgery 22 , 23 , 26 , 27 . These studies evaluated discharge to any post-acute care facility, without accounting for whether they were institutional or rehabilitative placements.…”

“…On one hand, it has been suggested that maintenance of care after surgery might reduce risk of readmission 19 , 24 , 25 . On the other hand, discharge to a post-acute care facility was an independent predictor of readmission after surgery 22 , 23 , 26 , 27 . Inpatient rehabilitation constitutes one of the only active interventions, as opposed to simply providing prolonged institutional care.…”

Strategies to minimize readmission rates following major urologic surgery

“…For example, variables expected to be associated with readmission such as age, sex, comorbidities and higher ASA scores are not consistently associated with readmissions. 6,9,10,12,25 Patient characteristics remain poor targets for modification in decreasing readmissions due to the fact they usually only explain a small fraction of deviation in final outcomes, and their risk factors (e.g. age, sex) are often not amenable to modifications.…”

“…Interestingly, those discharged to a skilled nursing facility or a rehabilitation facility (SNF) are more likely to have readmissions than those with other discharge destinations (home or home, with home health). 6,7 This is an interesting phenomenon and could stem from a few possible reasons: (1) patients going to SNF are sicker or had more complications during their index hospitalization and thus require more readmissions for underlying medical and surgical issues; (2) SNFs are not equipped with the understanding of complex surgeries (e.g. urinary diversions) their patients have undergone, leading to readmissions; or (3) the reliance on SNFs leads to a premature transference of care from the inpatient side before our patients are actually ready for discharge form acute hospital care.…”