EAU 2019: Trends and Predictors of 30-Day Readmissions Following Percutaneous Nephrolithotomy In Kidney Stone Former and Implications for Readmissions
Dr. Tully and colleagues demonstrated, that for a weighted sample of 6,974 patients who received PCNL at 485 hospitals, the 30-day readmission rate was 8.5% (95% CI 7.4 – 9.7). In the authors adjusted model, hospital characteristics such as surgical volume were not associated with an increased likelihood of readmission. Individual hospitals contributed marginally to their patients’ probability of readmission. Patient-level characteristics explained far more of the variability in readmissions than hospital characteristics (R squared 0.53963 vs 0.003).
In this proof of concept study, Dr. Tully and colleagues used of hospital readmission rates as a hospital quality metric has been debated as hospitals’ post-surgical readmission rates may be more due to patient factors (case mix) compared to hospital factors. It is not known whether a similar trend is present in advanced endoscopic procedures. We, therefore, sought to evaluate the contribution of individual hospitals on the patient-level probability of readmission after a typical high-risk endoscopic procedure, percutaneous nephrolithotomy (PCNL).
Based on their results, the authors concluded that hospital characteristics contribute marginally to hospital readmissions rates compared to level factor. Also, the authors underline that the hospital where surgery is performed barely influences the patients odd of readmissions. These findings underscore the potential limitations of 30-day post-discharge readmissions to evaluate hospital quality of care.
Presented by: Karl Tully, MD, Resident, Department of Urology, Marien Hospital Herne, Germany
Written by: Olesya Snurnitsyna, MD, Fellow, Department of Urology, Sechenov University, Moscow, Russia and Zhamshid Okhunov, MD, Twitter: @OkhunovZham, Department of Urology, the University of California-Irvin at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.