Association of hospital readmission following cystectomy with omission of postoperative chemotherapy in patients with urothelial carcinoma of the bladder.

Abstract

254 Background: Hypothesizing that complications after radical cystectomy requiring hospital re-admission may preclude subsequent systemic treatment, our objective was to test the association between readmission within 30 days of surgery and receipt of post-operative chemotherapy in Medicare beneficiaries. Methods: Using 1995-2007 linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data, all patients undergoing cystectomy for pathologic stage III-IV urothelial carcinoma were identified. Univariate and multivariate logistic regression analyses were used to test the association between hospital readmission within 30 days and receipt of post-operative chemotherapy (defined ≤9 months from surgery) adjusting for demographic, clinical, hospital, and procedural characteristics. Results: We identified 4,034 patients undergoing radical cystectomy for urothelial carcinoma, of which 1,498 met final inclusion criteria (mean age 75.9±6.3 years, 62.7% male). 563 patients (37.6%) were readmitted within 30 days of surgery (7.5% with ≥2 readmissions). Postoperative chemotherapy was administered in 26.1% of candidates who were readmitted, compared to 35.4% who were not readmitted following surgery (p<0.001). Following adjustment, the odds of receiving chemotherapy were 30% less in patients readmitted to the hospital (OR 0.70 [CI 0.53-0.92]) when compared to patients who were not readmitted. Stratified by number of readmissions, the odds of receiving chemotherapy in patients with 1 and ≥2 readmissions were 26% (OR 0.74 [CI 0.56-0.99]) and 54% (OR 0.46 [CI 0.27-0.79]) less when compared to patients not readmitted. Use of a more restrictive 6 month post operative chemotherapy definition did not significantly impact our findings (OR 0.66 [CI 0.47-0.93]). Conclusions: In a cohort of Medicare beneficiaries undergoing cystectomy, hospital readmission within 30 days is associated with omission of post-operative chemotherapy in patients with Stage III-IV urothelial carcinoma. These data inform treatment planning decisions and strengthen the argument supporting chemotherapy utilization in the neoadjuvant setting.