WBC Associates with Readmission Following Cystectomy

Abstract

Background: Radical cystectomy is associated with perioperative complication rates exceeding 50% in some series. Readmission rates are increasingly used as a surgical quality metric. White blood cell count is a crude surrogate for physiologic processes which may reflect postoperative complications leading to readmission.Objective: We assessed the association between final white blood cell count at discharge and risk of readmission following radical cystectomy.Methods: Records on 477 patients undergoing radical cystectomy from 2006–2013 were reviewed. Final white blood cell count was defined as the last documented value during index admission. Univariate analysis was performed using Fisher’s exact, Wilcoxon rank sum test, and Spearman’s coefficient tests where appropriate. Multivariable logistic regression models were used to test the associations between final white blood cell count and readmission.Results: 34% of patients were readmitted within 90 days of surgery. Amongst this cohort, a cutoff final white blood cell count of 9000/mm3 was identified, with a significantly higher proportion of patients with values >9000/mm3 experiencing readmission than those with values≤9000/mm3 (42% vs 28%, p = 0.004). Other perioperative variables associated with an increased readmission rate included initial hospital length of stay≤10 days, and receipt of a continent diversion. Following adjustment, final white blood cell count >9000/mm3 was associated with increased risk of readmission (OR 2.09, 95% CI 1.23–3.53, p = 0.006).Conclusions: Final white blood cell count is associated with hospital readmission following radical cystectomy. This metric may provide important guidance in discharge algorithms.

Population‐based analysis of perioperative chemotherapy use, interventions requiring hospitalization and atheroembolic events among patients with non‐metastatic muscle‐invasive bladder cancer

“…As a compliment to this dilemma, prior studies have also demonstrated a 5.7% reoperation rate in this study population 36 . Overall perioperative complications can reach as high as 58% within 90 days of RC 37 and readmission rates as high as 25–40% 38,39 Clinical trials aimed at minimizing complications, such as routine anticoagulation or heart rhythm monitoring (TRACING trial), 40 are encouraged in order to potentially avoid or detect ATEs at an earlier stage.…”

Different models for prediction of radical cystectomy postoperative complications and care pathways

“…In our analysis, additional variables, such as sarcopenia, leukocytosis, and hypoalbuminemia, were included as additional candidate predictor variables based on prior work that revealed associates with complications and readmissions after radical cystectomy. [23][24][25][26][27] As mentioned above, important variables such as surgeon experience, hospital volume, and surgical approach were not included in the analysis and may have meaningful effects on complication rates.…”