1598 HOSPITAL READMISSION AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER RESULTS OF A POPULATION-BASED ANALYSIS

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You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 20121598 HOSPITAL READMISSION AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER RESULTS OF A POPULATION-BASED ANALYSIS Kenneth Nepple, Pamela Owens, Seth Strope, Gundarshan Sandhu, Dorina Kallogjeri, and Adam Kibel Kenneth NeppleKenneth Nepple St. Louis, MO More articles by this author , Pamela OwensPamela Owens St. Louis, MO More articles by this author , Seth StropeSeth Strope St. Louis, MO More articles by this author , Gundarshan SandhuGundarshan Sandhu St. Louis, MO More articles by this author , Dorina KallogjeriDorina Kallogjeri St. Louis, MO More articles by this author , and Adam KibelAdam Kibel Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1371AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hospital readmission is a benchmark of surgical quality. Reports on readmission after cystectomy have been limited to the Medicare population over age 65 years or from large academic institutions. We sought to evaluate hospital readmission after radical cystectomy (RC) using a population-based all-payer data source which captures all readmissions to any hospital within the state. METHODS The study cohort was drawn from the California State Inpatient Database, a statewide discharge-based administrative database that includes all payers and age ranges. Revisit files allow single patients to be tracked across multiple admissions within the state. For the years 2005 to 2009, patients were identified who underwent RC for the diagnosis of bladder cancer with known type of urinary diversion. Hospital readmission rates were evaluated using Kaplan Meier analysis. Risk adjusted hazard ratios (HR) for readmission were assessed with multivariable logistic regression. RESULTS 3000 patients were identified who underwent extirpative surgery for bladder cancer, of which urinary diversion was ileal conduit in 2669 (89%) and continent diversion in 331 (11%). Patients with continent diversion were more likely to be male, white, and from higher income areas compared with ileal conduit (all p<0.02). Medical comorbidity was more common in patients with ileal conduit diversion (p<0.05 for deficiency anemia, COPD, and renal insufficiency). Median hospital stay was 9 days for both types of urinary diversion. Mortality during the surgical admission for ileal conduit (2.3%) and continent diversion (3.0%) were not statistically different (p=0.38). The overall hospital readmission rate was 27.1% at 30 days and 38.0% at 90 days (Figure). 32.2% of readmissions were to a different hospital than where the cystectomy was performed. On multivariable analysis, predictors (p<0.05) of readmission were older age (HR 1.01 per year), CHF (HR 1.41), depression (HR 1.60), diabetes (HR 1.34), psychoses (HR 1.82), renal insufficiency (HR 1.36), and continent diversion (HR 1.30). CONCLUSIONS In a large comprehensive state inpatient database, 38.0% of patients were readmitted to the hospital within 90 days after RC. Predictors of hospital readmission included increased age, medical comorbidity, and continent urinary diversion. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e646-e647 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenneth Nepple St. Louis, MO More articles by this author Pamela Owens St. Louis, MO More articles by this author Seth Strope St. Louis, MO More articles by this author Gundarshan Sandhu St. Louis, MO More articles by this author Dorina Kallogjeri St. Louis, MO More articles by this author Adam Kibel Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...