Authors: Skolarus TA, Jacobs BL, Schroeck FR, He C, Helfand AM, Helm J, Hu M, Lavieri M, Hollenbeck BK
Title: Understanding Readmission Intensity After Radical Cystectomy.
Journal: J Urol :-
Date: 2014 Nov 04
Abstract: INTRODUCTION: Readmissions after radical cystectomy vary with respect to their intensity, both in terms of their impacts on patients and healthcare systems. For this reason, we conducted a population-based study to examine factors associated with increasing readmission intensity after radical cystectomy for bladder cancer. METHODS: Using SEER-Medicare data, we identified 1782 patients who underwent radical cystectomy from 2003-2009. We defined readmission intensity in terms of length of stay (LOS) sorted into quartiles: <3 (lowest), 3-4, 5-7 and >7 days (highest). We used logistic regression to examine factors associated with readmission intensity. RESULTS: Over half of patients with highest intensity readmissions were readmitted within the first week and 77% were readmitted within 2 weeks of discharge. Patients with the highest intensity readmissions were similar in age, gender, race, socioeconomic status, pathologic stage, comorbidity, neoadjuvant chemotherapy use, and urinary diversion type when compared to patients with the lowest intensity readmissions. After multivariable adjustment, complications during the index cystectomy admission (p<0.001), readmission week (p=0.04) and the interaction between index length of stay and discharge to a skilled nursing facility (p=0.04) were associated with highest readmission intensity. CONCLUSIONS: Readmission intensity differs widely after discharge following radical cystectomy. As post-surgical efforts to minimize the readmission burden increase, a better understanding of what factors contribute to highest intensity readmissions will help direct limited resources (e.g., phone calls, office visits) toward high yield areas.
Last Modified: 03 Sep 2013