Hospitalization and Readmission Costs after Radical Cystectomy in a Nationally Representative Sample: Does Urinary Reconstruction Matter?

To investigate the impact of continent urinary diversion on readmissions and hospital costs in a nationally representative sample of radical cystectomies (RC) performed in the United States.

The 2010-2014 Nationwide Readmissions Database was queried for patients with a diagnosis of bladder cancer who underwent RC. We identified patients undergoing continent (neobladder or continent cutaneous reservoir) or incontinent (ileal conduit) diversions. Multivariable logistic regression models were used to identify predictors of 90-day readmission, prolonged length of stay, and total hospital costs.

Among 21,126 patients identified, 19,437 (92.0%) underwent incontinent diversion while 1,689 (8.0%) had a continent diversion created. Continent diversion patients were younger, healthier, and treated at high volume metropolitan centers. Continent diversions resulted in fewer in-hospital complications (37.3% vs. 42.5%, p = 0.02) but led to more 90-day readmissions (46.5% vs. 39.6%, p = 0.004). In addition, continent diversion patients were more often readmitted for infectious complications (38.7% vs. 29.4%, p = 0.004) and genitourinary complications (18.5% vs. 13.0%, p = 0.01). On multivariable logistic regression, patients with a continent diversion were more likely to be readmitted within 90 days (OR 1.55, 95% CI [1.28, 1.88]) and have increased hospital costs during initial hospitalization (OR 1.99, 95% CI [1.52, 2.61]). Continent diversion led to a $4,617 increase in initial hospital costs ($36,640 vs. $32,023, p <0.001) which is maintained at 30 days ($48,621 vs. $44,231, p <0.001) and at 90 days ($56,380 vs. $52,820, p <0.001).

In a nationally representative sample of RCs performed in the United States, continent urinary diversion led to more frequent readmissions and increased hospital costs. Interventions designed to address specific outpatient issues with continent diversions can potentially lead to a significant decrease in readmissions and associated hospital costs. This article is protected by copyright. All rights reserved.

BJU international. 2018 Jun 13 [Epub ahead of print]

Gregory A Joice, Meera R Chappidi, Hiten D Patel, Max Kates, Nikolai A Sopko, C J Stimson, Phillip M Pierorazio, Trinity J Bivalacqua

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.