ACS 2019: Readmission after Radical Cystectomy Based on Discharge Destination

San Francisco, California ( Julianne R. Rathbun, MD, general surgeon, University of Missouri, Columbia, Missouri highlighted radical cystectomy (RC) with urinary diversion for muscle-invasive urothelial cell carcinoma of the bladder is an aggressive intervention with high morbidity secondary to high readmission rates and complications. She performed a study which aimed to determine readmission rates after hospitalization for RC dependent on discharge destination of a nursing facility or home (with or without home health nursing).

 The HealthFacts Database was utilized to identify patients with inpatient admission undergoing RC with urinary diversion and diagnosis of bladder cancer between 2010-2015. The location of discharge after index admission was determined. Readmissions within 30 days were evaluated for primary and secondary diagnoses.

A total of 855 patients met inclusion criteria; the majority were male (82%) with a median age of 69 years. The discharge destination was home (86%), skilled nursing facility (SNF, 10%) or rehabilitation facility (4%). The length of stay was five days for 50% and less than 14 days for 90%. Sixteen percent were readmitted within 30 days; the majority within two weeks (40% in first, another 30% in second). Patients younger than 80 were more likely to be readmitted (p=0.0194). The location of the discharge destination approached statistical significance with discharge to SNF having the lowest readmission rate (p=0.0693).

In summary, identifying the preoperative functional status of patients may help predict the most appropriate discharge destination to reduce the readmissions in the first 30 days from discharge, especially early readmissions within the first week (32% between days 2-6). The focus should be placed on preventing early readmissions. Discharge destination may have an impact on readmission rates and reasons and should be further investigated.

While interesting, limitations in the current study with lack of granularity regarding patient, surgeon and hospital characteristics with potential nesting of data make the findings inconclusive. Moreover, there was no assessment of early recovery after surgery (ERAS) use or length of stay between subgroups. The authors should be commended, and further research needed to improve bladder cancer care following surgery.

Presented by: Julianne R. Rathbun, MD, general surgeon, University of Missouri, Columbia, Missouri

Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX at the 2019 American College of Surgeons (ACS), #ACSCC19, October 27–31 in San Francisco, California