Causes, Timing, Hospital Costs, and Perioperative Outcomes Of Index vs. Non-Index Hospital Readmissions Following Radical Cystectomy: Implications For Regionalization of Care

To compare the timing, causes, hospital costs, and perioperative outcomes of index vs. non-index hospital readmissions following radical cystectomy.

The 2013 Nationwide Readmissions Database was queried for bladder cancer patients undergoing cystectomy. Sociodemographic characteristics, hospital costs, and causes of readmission were compared among index and non-index readmitted patients. Univariable and multivariable logistic regression models were used to identify predictors of non-index readmissions, mortality during the first readmission, and subsequent readmission.

Among 4991 patients identified, 29%(1447/4991) and 11%(571/4991) experienced an index and non-index readmission, respectively. Compared to index readmissions, non-index readmissions were more likely late readmissions (p<0.001) of older patients (p=0.047) that had cystectomies at higher volume hospitals (p=0.02) and were readmitted to hospitals located in less populated areas (p<0.001). Compared to index readmissions, the percentage of non-index readmissions for cardiovascular complications was higher (7.6% vs. 2.9%, p=0.003) while the percentage of non-index readmissions for gastrointestinal (6.0% vs. 11.0%, p=0.04) and wound (5.3% vs. 16.7%, p=0.0001) complications was lower. Predictors of non-index readmission included longer length of stay (OR=1.02 95%CI[1.001,1.04]), patient location in less populated areas, non-teaching hospital (OR=0.52, 95%CI[0.31,0.86]), and discharge to facility (OR=2.82 95%CI[1.75,4.55]) or with home health (OR=1.49, 95%CI[1.05,2.10]). Non-index readmissions had comparable mean readmission hospital costs ($14,147 vs. $15,102, p=0.7), in-hospital mortality (OR=1.11, 95%CI[0.42, 2.87]), and subsequent readmission (OR=1.32, 95%CI[0.87, 2.00]) to index readmissions.

This nationally representative study of cystectomy patients demonstrated comparable perioperative outcomes and hospital costs between index and non-index readmitted RC patients, which supports the continued regionalization of cystectomy care.

The Journal of urology. 2016 Aug 18 [Epub ahead of print]

Meera R Chappidi, Max Kates, C J Stimson, Michael H Johnson, Phillip M Pierorazio, Trinity J Bivalacqua

The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine. Electronic address: ., The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine.