30-day readmission after radical cystectomy: Identifying targets for improvement using the phases of surgical care

  • Ian Berger University of Pennsylvania Perelman School of Medicine
  • Leilei Xia Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine
  • Christopher Wirtalla Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine
  • Phillip Dowzicky Department of Surgery, University of Pennsylvania Perelman School of Medicine
  • Thomas J. Guzzo Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine
  • Rachel R. Kelz Department of Surgery, University of Pennsylvania Perelman School of Medicine
Keywords: radical cystectomy, readmission, surgical care

Abstract

Introduction: Postoperative readmissions following radical cystectomy (RC) have gained attention in the past decade. Postoperative and post-discharge complications play a role in readmission rates; however, our ability to predict readmissions remains poor.

Methods: Using the National Surgical Quality Improvement Program database, we identified patients with bladder cancer undergoing RC from 2013–2015. Complications were defined as postoperative and post-discharge. Outcomes were 30-day readmission, post-discharge complications, and post-discharge major complications. Patient, operative, and complication factors were assessed using multivariable logistic regression.

Results: We identified 4457 patients who underwent RC; 9.2% of patients experienced a postoperative complication, 18.8% experienced a post-discharge complication, and 20.3% were readmitted. Overweight and obese body mass index (BMI), dependent functional status, chronic obstructive pulmonary disease (COPD), a continent diversion, and duration of operation were associated with post-discharge complications. Postoperative complications were not associated with post-discharge complications. Readmission was associated with Black race (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.0–2.1), overweight (OR 1.5; 95% CI 1.2–1.8) and obese BMI (OR 1.5; 95% CI 1.2–1.9), diabetes (OR 1.2; 95% CI 1.0–1.5), COPD (OR 1.4; 95% CI 1.0–1.8), steroid use (OR 1.5; 95% CI 1.0–2.2), a continent diversion (OR 1.4; 95% CI 1.1–1.7), duration of operation (OR 1.1; 95% CI 1.1–1.2), and postoperative complications (OR 1.5; 95% CI 1.2–2.0). The majority of readmissions experienced a post-discharge complication.

Conclusions: Factors that span the preoperative, intraoperative, postoperative, and post-discharge phases of care were identified to increase readmission risk. To improve readmission rates, interventions will have to target factors across the surgical experience.

Published
2018-11-20
How to Cite
Berger, I., Xia, L., Wirtalla, C., Dowzicky, P., Guzzo, T. J., & Kelz, R. R. (2018). 30-day readmission after radical cystectomy: Identifying targets for improvement using the phases of surgical care. Canadian Urological Association Journal, 13(7). https://doi.org/10.5489/cuaj.5455
Section
Original Research