INTRODUCTION AND OBJECTIVES - Radical cystectomy (RC) is associated with high complication and readmission rates. An understanding of root-causes for readmissions and the modifiability of factors contributing to readmissions may decrease morbidity associated with RC.
We sought to characterize indications for readmission following RC and to determine whether these indications represent immutable patient disease and procedure factors or whether they are modifiable.
METHODS - From MarketScan databases, we identified patients under the age 65 with a diagnosis of bladder cancer undergoing RC between 2008 and 2011 readmitted within 30 days of RC. All associated ICD-9 codes within the index admission, subsequent outpatient claims, and readmission claims were independently reviewed by three surgeons to determine a root-cause for readmission. Causes were broadly categorized as being medical, surgical, or infectious, and reviewers determined whether the readmission was modifiable. Multivariate logistical regression models were used to identify factors associated with readmission.
RESULTS - 1,163 patients were included. 242 (21%) patients were readmitted within 30 days. 26% of readmissions were considered modifiable (kappa=0. 71). Of non-modifiable readmissions, an infectious cause accounted for 52% and a medical cause accounted for 48%. Of the modifiable readmissions, 62% were due to surgical, 30% to medical, and 8% to infectious causes. On multivariate analysis, only discharge to a skilled nursing facility was associated with either modifiable (OR 6. 12, 95% CI 2. 32-16. 14) or non-modifiable readmissions (OR 3. 27, 95% CI 1. 63-6. 53).
CONCLUSIONS - The majority of readmissions following RC are attributable its inherent morbidity. However, optimization of aspects of peri-cystectomy care could minimize RC's morbidity.
The Journal of urology. 2015 Nov 07 [Epub ahead of print]
Andrew C James, Jason P Izard, Sarah K Holt, Joshua K Calvert, Jonathan L Wright, Michael P Porter, John L Gore
Department of Urology, University of Kentucky School of Medicine, Lexington, KY. Department of Urology, Queens University, Kingston, ON, Canada. , Department of Urology, University of Washington School of Medicine, Seattle, WA. , Department of Urology, University of Washington School of Medicine, Seattle, WA. , Department of Urology, University of Washington School of Medicine, Seattle, WA. , Department of Urology, University of Washington School of Medicine, Seattle, WA; Puget Sound Veterans Affairs Health Care System, Seattle, WA. , Department of Urology, University of Washington School of Medicine, Seattle, WA.