Characterizing "Bounce-back" Readmissions After Radical Cystectomy.

To examine predictors of early readmissions following radical cystectomy. Factors associated with preventable readmissions may be most evident in readmissions that occur within 3 days of discharge, commonly termed "bounce-back" readmissions, and identifying such factors may inform efforts to reduce surgical readmissions.

We utilized the Healthcare Cost and Utilization Project's State Inpatient Databases to examine 1,867 patients undergoing cystectomy in 2009 and 2010 and identified all patients readmitted with 30 days of discharge. We assessed differences between patients experiencing bounce-back readmission compared to those readmitted 8-30 days after discharge using logistic regression models and also calculated abbreviated LACE scores to assess the utility of common readmissions risk stratification algorithms.

Thirty day and bounce-back readmission rates were 28.4% and 5.6%, respectively. Although no patient or index hospitalization characteristics were significantly associated with bounce-back readmissions in adjusted analyses, bounce-back patients did have higher rates of gastrointestinal (14.3% vs 6.7%, p=0.02) and wound (9.5% vs 3.0%, p<0.01) diagnoses as well as increased index and readmission length of stay (5 vs 4 days, p=0.01). Overall median abbreviated LACE score was 7, which fell into the moderate readmission risk category, and no difference was observed between readmitted and non-readmitted patients.

One in five readmissions following radical cystectomy occurs within three days of initial discharge, likely due to factors present at discharge. However, sociodemographic and clinical factors as well as traditional readmission risk tools were not predictive of this bounce-back. Effective strategies to reduce bounce-back readmission must identify actionable clinical factors prior to discharge. This article is protected by copyright. All rights reserved.

BJU international. 2019 Jul 17 [Epub ahead of print]

Peter S Kirk, Ted A Skolarus, Bruce L Jacobs, Yongmei Qin, Benjamin Li, Michael Sessine, Xiang Liu, Kevin Zhu, Scott M Gilbert, Brent K Hollenbeck, Ken Urish, Jonathan Helm, Mariel S Lavieri, Tudor Borza

Dow Division of Health Services Research, Department of Urology, University of Michigan Health System., Department of Urology, University of Pittsburgh, School of Medicine., Department of Industrial and Operations Engineering, University of Michigan., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute., Department of Orthopaedic Surgery, University of Pittsburgh, School of Medicine., Department of Operations and Decision Technologies, Kelley School of Business, Indiana University., Department of Urology, University of Wisconsin.