Early Discharge and Post-Discharge Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer

To assess whether discharging patients early after radical cystectomy (RC) is associated with increased risk of readmissions and post-discharge complications.

The National Surgical Quality Improvement Program (NSQIP) database was queried to identify patients who underwent an elective RC from 2012 to 2015. Patients were stratified into two groups: those with hospital length of stay (LOS) of 4-5 days (early-discharge) and those with LOS of 6-9 days (routine-discharge). We used multivariable logistic regressions to assess the impact of early-discharge on 30-day readmission and post-discharge complication rates. Sensitivity analyses and subgroup analyses were performed to validate the robustness of our primary analyses.

A total of 3,311 patients were included. Unadjusted outcomes comparison showed no difference in readmission rate (21.6% vs. 23.0%) or post-discharge complication rate (17.7% vs. 19.6%) between early-discharge and routine-discharge groups. Multivariable logistic regression also showed early discharge was not associated with increased odds of readmission (OR=1.00, 95%CI=0.82-1.22, P=1.000) or post-discharge complication (OR=0.95, 95%CI=0.77-1.17, P=0.616). Two-step sensitivity analyses (excluding patients with LOS of 8-9 days followed by patients with any pre-discharge adverse event) validated the robustness of our primary analyses. Subgroup analyses also showed similar results in all subgroups except the subgroup of patients with age ≥ 85 years.

Early discharge after RC was not associated with readmissions or post-discharge complications. Future prospective studies, with defined perioperative care pathways, are needed to identify potential components that may enable hospitals to discharge patients early without compromising post-discharge outcomes. This article is protected by copyright. All rights reserved.

BJU international. 2017 Oct 24 [Epub ahead of print]

Leilei Xia, Benjamin L Taylor, Andrew D Newton, Aseem Malhotra, Jose E Pulido, Marshall C Strother, Thomas J Guzzo

Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.