Risk factors of hospital readmission after radical cystectomy and urinary diversion: analysis of a large contemporary series

Abstract

ObjectivesTo determine the incidence, risk factors and causes of hospital readmission in a large series of patients who underwent radical cystectomy (RC) and urinary diversion. Patients and MethodsWe retrospectively analysed the data of 1000 patients who underwent RC and urinary diversion between January 2004 and September 2009 in our tertiary referral centre. Patients stayed in hospital for 21 and 11 days for orthotopic and ileal conduit diversions, respectively. The primary outcome was the development of a complication requiring hospital readmission at ≤3 months (early) and >3 months (late). Causes of hospital readmissions were categorised according to frequency of readmissions. Predictors were determined using univariate and multivariate logistic regression models. ResultsIn all, 895 patients were analysed excluding 105 patients because of perioperative mortality and loss to follow-up. Early and late readmissions occurred in 8.6% and 11% patients, respectively. The commonest causes of first readmission were upper urinary tract obstruction (UUO, 13%) and pyelonephritis (12.4%) followed by intestinal obstruction (11.9%) and metabolic acidosis (11.3%). The development of postoperative high-grade complications (odds ratio [OR] 1.955; 95% confidence interval [CI] 1.254-3.046; P = 0.003) and orthotopic bladder substitution (OR 1.585; 95% CI 1.095-2.295; P = 0.015) were independent predictors for overall hospital readmission after RC. Postoperative high-grade complications (OR 2.488; 95% CI 1.391-4.450; P = 0.002), orthotopic bladder substitution (OR 2.492; 95% CI 1.423-4.364; P = 0.001) and prolonged hospital stay (OR 1.964; 95% CI:1.166-3.308; P = 0.011) were independent predictors for early readmission while hypertension (OR 1.670; 95% CI 1.007-2.769; P = 0.047) was an independent predictor for late readmission. ConclusionHospital readmissions are a significant problem after RC. In the present study, UUO, pyelonephritis, metabolic acidosis and intestinal obstruction were the main causes of readmission. Orthotopic bladder substitution and development of postoperative high-grade complications were significant predictors for overall readmission.

Adhesive Bowel Obstruction Following Urologic Surgery: Improved Outcomes with Early Intervention

“…Our reported 5-year cumulative incidence of ASBO for each procedure is higher than rates currently reported in the literature, even after censoring patients who had subsequent abdominal procedures: RadCx 12.4%, compared to 1.1-11.9% [3,4,5]; RP 0.9%, compared to open RP (0.4%) [8] and robotic RP (0.09%) [7]; and KS 3.3%, compared to radical nephrectomy (0.6%) [6]. Our higher rates likely provide a more accurate representation of the incidence of ABSO following urologic surgery.…”

“…Reports of ASBO in urologic patient populations are sparse, but ASBO is a known complication of radical cystectomy (RadCx) [3,4,5], kidney surgery (KS) [6], and radical prostatectomy (RP) [7,8]. …”

Thirty-day complications of radical cystectomy and factors that influence their development

“…Осложнения инфекционной природы считаются одними из наиболее частых и сложных категорий осложнений после проведения РЦЭ, составляют 20,5-33,0 % и в большинстве случаев являются причиной повторной госпитализации [1,[21][22][23][24][25][26][27]. По данным …”

“…A. M. Harraz и соавт., у 1000 проанализированных па-циентов, перенесших РЦЭ, наиболее частыми причи-нами повторных госпитализаций были обструкции верхних мочевых путей, инфекция мочевых путей (пиело-нефрит), кишечная непроходимость и метаболический ацидоз [26]. Даже после лапароскопических и робот-ассистированных цистэктомий осложнения инфекци-онного характера примерно в 41 % случаев являются причиной повторных госпитализаций [28,29].…”

How Octogenarians with Bladder Cancer Are Treated in a Maximum-Care Hospital: The Real-Life Experience

“…In addition to age and comorbidities, another reason for the reluctance to perform a RC may be the complexity of performing a RC. Performing RC with urinary diversion is a very challenging procedure that has many perioperative risks, such as upper urinary tract obstruction, acidosis or ileus, especially in frail patients with comorbidities [22,23] . The rate of perioperative complications depends not only on the age and general health of the patient but also on a clinic's caseload and surgeon's experience.…”