Understanding Hospital Readmission Intensity after Radical Cystectomy

Skolarus, Ted A.; Jacobs, Bruce L.; Schroeck, Florian R.; He, Chang; Helfand, Alexander M.; Helm, Jonathan E.; Hu, Michael S.; Lavieri, Mariel S.; Hollenbeck, Brent K.

doi:10.1016/j.juro.2014.10.107

Cited by 48 publications

(32 citation statements)

References 24 publications

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“…Despite the lack of a difference, we highlight the fact that readmissions following cystectomy are high intensity stays as most readmitted patients had multiple new diagnoses at the time of readmission, and the readmission LOS was 5 days following open cystectomy and 4 days following RARC. 16 Emergency department use was substantial in both cohorts, with just under one quarter of patients seen within 30 days of discharge, but did not differ significantly by approach. 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.…”

Section: Discussionmentioning

confidence: 85%

“…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: 98%

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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: 85%

Section: Discussionmentioning

confidence: 98%

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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“…Skolarus et al [23] used SEER-Medicare data and identified 1782 patients who underwent a radical cystectomy between 2003 and 2009 and found that 25.5 % of patients were readmitted within 30 days. After categorizing the readmissions by length-of-stay intensity defined as <3 days, 3-4 days, 5-7 days, and >7 days, they found no difference in length-of-stay intensity when stratified by age or by type of urinary diversion.…”

Section: Complicationsmentioning

confidence: 99%

Orthotopic urinary diversion in the elderly

Hugen

Daneshmand

2015

World J Urol

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“…One study using data from the Healthcare Cost and Utilization Project's State Impatient Database examined patients undergoing similarly high‐risk abdominal surgery (including open abdominal aortic aneurysm repair, cystectomy, esophagectomy, and pancreatectomy) and found that 19.4% of patients were discharged to a skilled nursing facility, which is similar to the rate of 22.8% found in this study. Another study looked at 30‐day readmission intensity in cystectomy patients using Surveillance, Epidemiology, and End Results‐Medicare data and found that 77% of readmissions occurred within the first week of discharge . This study, however, was limited to 30 days of follow‐up and therefore was not able to assess readmissions over the course of the year following surgery, as was done in our study.…”

Section: Discussionmentioning

confidence: 90%

Time Spent Away from Home in the Year Following High‐Risk Cancer Surgery in Older Adults

Suskind

Zhao

Boscardin

et al. 2020

J American Geriatrics Society

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OBJECTIVES To understand where older adults spend time (at home, in the hospital, or in a nursing home) in the year following high‐risk cancer surgery. DESIGN Retrospective cohort study. SETTING Medicare beneficiaries using data from Medicare Inpatient claims to ascertain hospital days and the Minimum Data Set to ascertain nursing home days. PARTICIPANTS Beneficiaries who underwent high‐risk cancer surgery (cystectomy, pancreaticoduodenectomy, gastrectomy, or esophagectomy) were identified to determine cumulative time spent away from home in the year following surgery. MEASUREMENTS Adjusted percentages of time spent away from home (ie, days in a hospital or nursing home) were modeled for the year following surgery. RESULTS A total of 37 748 beneficiaries underwent high‐risk cancer surgery during the study period, and 28.3% died within 1 year. Overall, beneficiaries spent 13.9 ± 26.2 days in the hospital (over 1.5 ± 2.0 hospital readmissions) and 37.2 ± 50.6 days in the nursing home (over 1.5 ± 1.0 admissions) in the year following surgery. Among beneficiaries who were alive and dead at 1 year, 18.5% and 30.1% of time was spent away from home, respectively. Beneficiaries who were initially discharged to a facility following surgery and died within 1 year spent 44.4% of their final year away from home. CONCLUSION Time spent away from home in the hospital and/or nursing home in the year following high‐risk cancer surgery is substantial among Medicare beneficiaries. This information is crucial in counseling patients on postoperative expectations and may additionally influence preoperative decision making. J Am Geriatr Soc 68:505–510, 2020

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Understanding Hospital Readmission Intensity after Radical Cystectomy

Cited by 48 publications

References 24 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

Orthotopic urinary diversion in the elderly

Time Spent Away from Home in the Year Following High‐Risk Cancer Surgery in Older Adults

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