Early discharge does not increase readmission rate in patients robotic assisted radical cystectomy with enhanced recovery protocol

Abstract

Objectives: We aim to assess if short LoS following robot-assisted radical cystectomy (RARC) with Enhanced Recovery Protocol (ERP) is associated with increased readmission rate and analyse the impact of rehospitalisation in tertiary versus referral hospitals on outcomes. Methods: Between April 2013 and December 2017, 255 (198 male and 57 female) patients underwent RARC with newly devised multimodal ERP that incorporated all the elements of EAU Robotic Urology Consensus. Analysis of prospectively collected data on LoS and postoperative readmission to demographic and perioperative variables was performed. Results: The median age at treatment was 71 years old, 76% were males, 72% had a BMI <30kg/m2, 81% an ASA score ≤2 and 72% a CPET anaerobic threshold ≥11. The median LOS was 5 days (1st-3rd IQR: 4-7 days). Post-operative day 4 was the most frequent day of discharge from hospital. The incidence of post-operative complications was 42% for minor (Clavien-Dindo grade ≤ II) and 8% for major (grade ≥ III) complications. The occurrence of 30- and 90-day readmission to hospital was 13.9% and 16.5% respectively. Post procedure complications were the only factor significantly associated with readmissions whilst LoS did not significantly correlate with readmissions. 41% of readmissions happened in the tertiary centre and 59% in one of the referral hospitals. 31% of readmissions were infection related (urinary, pelvic collection, lymphocele) and 28% gastrointestinal (ileus, small bowel obstruction). Of the 38 incidents, 12 were considered as potentially avoidable (back pain, scrotal oedema, oral candidiasis). Conclusion: The results from our centre demonstrate that short length of hospital stay does not affect consistently low readmission rates. This illustrates a favourable patient outcome for a procedure associated with inherent morbidity as a result of minimally invasive approach and multimodal enhanced recovery protocol. The optimisation of the post-discharge regionalised network can further reduce rehospitalisation and minimise the risk of service fragmentation within a tertiary referral facility. Disclosure of Interest: None declared.