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. 2022 Apr;40(4):164.e1-164.e7.
doi: 10.1016/j.urolonc.2021.09.001. Epub 2021 Oct 8.

Clinical indications for necessary and discretionary hospital readmissions after radical cystectomy

Ahmet Murat Aydin  1 , Richard R Reich  2 , Biwei Cao  2 , Salim K Cheriyan  3 , Ali Hajiran  3 , Logan Zemp  3 , Alice Yu  3 , Michael A Poch  3 , Wade J Sexton  3 , Roger Li  3 , Scott M Gilbert  4
Affiliations

Clinical indications for necessary and discretionary hospital readmissions after radical cystectomy

Ahmet Murat Aydin et al. Urol Oncol. 2022 Apr.

Abstract

Background: To assess predictors, indicators and medical necessity of readmissions after neoadjuvant chemotherapy and radical cystectomy in order to identify opportunities for reducing readmission rates.

Methods: Records for patients treated with cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy between 2007 and 2017 were reviewed for 90-day complications and readmission. Readmissions were classified as necessary vs. discretionary based on independent clinician review. The association between postoperative complications and necessary or discretionary readmission were examined with adjusted regression models.

Results: Among a total of 250 patients, 76 patients (30.4%) were readmitted within 90 days of surgery (19 discretionary and 57 necessary). Age, insurance coverage, and comorbidity were similar between readmitted and non-readmitted patients. Readmission was more likely after neobladder than ileal conduit (39% vs. 23%, P = 0.02). Major (grade ≥ 3) complications within 90-day of surgery including index admission and post-discharge period were significantly more common among re-admitted patients compared to patients who were not readmitted (40% in necessary, 21% in discretionary, 3% in none, P < 0.001). Median length of stay on readmission was twice as long in necessary cases compared to discretionary cases (5 vs. 2.5 days, P < 0.001). Gastrointestinal and infectious complications were associated with discretionary readmission in adjusted analyses, while infectious, renal/genitourinary and thromboembolic complications were associated with necessary readmission.

Conclusions: Twenty-five percent of readmissions were categorized as discretionary and were driven primarily by low-grade gastrointestinal complications, marginal oral intake and failure to thrive, suggesting that better coordinated post-discharge supportive care could help avoid a substantial proportion of readmissions.

Keywords: Complications; Cystectomy; Muscle-invasive bladder cancer; Neoadjuvant chemotherapy; Patient readmission; Urinary bladder cancer.

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Conflict of interest statement

Conflict of Interest Statement The authors declare no conflict of interest.

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