MP24-18 THE IMPACT OF READMISSIONS TO SECONDARY HOSPITALS ON FAILURE-TO-RESCUE RATES FOLLOWING MAJOR UROLOGIC CANCER SURGERY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness III1 Apr 2015MP24-18 THE IMPACT OF READMISSIONS TO SECONDARY HOSPITALS ON FAILURE-TO-RESCUE RATES FOLLOWING MAJOR UROLOGIC CANCER SURGERY Jasmir Nayak, Sarah Holt, Jonathan Wright, Atreya Dash, and John Gore Jasmir NayakJasmir Nayak More articles by this author , Sarah HoltSarah Holt More articles by this author , Jonathan WrightJonathan Wright More articles by this author , Atreya DashAtreya Dash More articles by this author , and John GoreJohn Gore More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1160AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urological cancer surgery is complex with some suggesting centralization of certain procedures in an effort to improve outcomes and reduce morbidity. Morbidity extends beyond the index surgery and can be further reduced by effective peri-operative complication management. Although outcomes vary among hospitals, part of this may be attributed to differences in the failure-to-rescue (FTR) complications. We examined FTR rates and compared those readmitted to their index surgery hospital with those readmitted to a secondary hospital. METHODS We accessed the Washington State Comprehensive Hospital Abstract Reporting System from 2009-2013. ICD-9 codes identified patients who underwent radical prostatectomy (RP), radical cystectomy (RC), partial nephrectomy (PN), radical nephrectomy (RN) and retroperitoneal lymph node dissection (RPLND) for malignancy. FTR in this analysis was defined as death following readmission within 90 days of the index surgery. Primary (PH) and secondary hospitals (SH) were defined using hospital identifiers linked to unique admissions. Multivariable logistic regression models were used to identify factors associated with FTR. RESULTS 11,536 patients underwent urologic cancer surgery, of whom 61% underwent RP, 22% RN, 10% PN, 6% RC and 1% RPLND. Overall, 10% (range: 6-37%) were readmitted within 90 days of surgery. 61% were readmitted to their PH, although this varied according to procedure type (57% readmitted to PH after RP, compared with 60% after RN, 65% after PN, 67% after RC and 83% after RPLND). The likelihood of readmission to the PH decreased with increasing hospital volume (p<0.0001). Overall FTR rate was 4%, ranging from 0% for RPLND to 6% for RN. The FTR rate when presenting to the PH was 1.5% compared with 6.6% at a SH (p=0.002). The most common readmission diagnoses were renal failure (24%), sepsis (10%), venothromboembolic event (9%) and pneumonia (8%). Controlling for age, sex, comorbidities and hospital volume, the readmission hospital was independently associated with FTR (OR 0.39, 95% CI 0.21-0.74 for PH versus SH). CONCLUSIONS Hospital readmissions within 90 days of major urologic cancer surgery are associated with a low FTR rate; however, patients readmitted to a SH experienced higher FTR than those readmitted to their original hospital. These findings may inform clinical decision-making around hospital transfers and aid future quality improvement initiatives to reduce the morbidity associated with complex urologic oncology surgeries. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChappidi M, Kates M, Stimson C, Johnson M, Pierorazio P and Bivalacqua T (2018) Causes, Timing, Hospital Costs and Perioperative Outcomes of Index vs Nonindex Hospital Readmissions after Radical Cystectomy: Implications for Regionalization of CareJournal of Urology, VOL. 197, NO. 2, (296-301), Online publication date: 1-Feb-2017.Lenis A and Chamie K (2018) Regionalization of Cystectomy: Importance of Care Coordination, Bundled Payments and Surgical OwnershipJournal of Urology, VOL. 197, NO. 2, (278-279), Online publication date: 1-Feb-2017. Volume 193Issue 4SApril 2015Page: e283-e284 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jasmir Nayak More articles by this author Sarah Holt More articles by this author Jonathan Wright More articles by this author Atreya Dash More articles by this author John Gore More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...