MP24-19 PATTERNS OF CARE FOR READMISSION FOLLOWING RADICAL CYSTECTOMY IN NEW YORK STATE: DOES THE HOSPITAL MATTER?

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness III1 Apr 2015MP24-19 PATTERNS OF CARE FOR READMISSION FOLLOWING RADICAL CYSTECTOMY IN NEW YORK STATE: DOES THE HOSPITAL MATTER? Jamie S. Pak, Danny Lascano, Daniel Kabat, Julia B. Finkelstein, Mark V. Silva, G. Joel DeCastro, William Gold, and James M. McKiernan Jamie S. PakJamie S. Pak More articles by this author , Danny LascanoDanny Lascano More articles by this author , Daniel KabatDaniel Kabat More articles by this author , Julia B. FinkelsteinJulia B. Finkelstein More articles by this author , Mark V. SilvaMark V. Silva More articles by this author , G. Joel DeCastroG. Joel DeCastro More articles by this author , William GoldWilliam Gold More articles by this author , and James M. McKiernanJames M. McKiernan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1161AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy (RC) is a notoriously morbid procedure, leading to high rates of postoperative complications and hospital readmission. The Statewide Planning and Research Cooperative System (SPARCS) is a comprehensive all-payer database maintained by the New York State (NYS) Department of Health on inpatient and outpatient visits of NYS residents. The aim of this study was to describe the patterns of care for 30- and 90-day readmissions after RC and to determine if readmission to the original hospital (OH) versus an outside hospital (OSH) had an impact on outcomes. METHODS The SPARCS database was queried for all RCs with discharges between 1/1/2009 and 9/31/2012 in NYS. Readmissions at 30 and 90 days were stratified into OH versus OSH, and outcomes were analyzed accordingly. Chi-square analysis and t-test were utilized to compare patient characteristics and outcomes. RESULTS During the study period, 2338 NYS residents were discharged after RC. Overall rate of readmission was 28.1% within 30 days and 39.2% within 90 days. Readmitted patients were more commonly male (90.0% vs. 85.3%, p=0.001). Age, race, and primary payer were not significantly different between readmitted and nonreadmitted patients. The percentage of all readmitted patients who were readmitted to OH was 80.4% and 77.1% within 30 and 90 days, respectively. Patients readmitted to OH vs. OSH were younger (30-day weighted average median value [WAMV] of 68.8 vs. 73.1, p<0.0005; 90-day WAMV of 69.2 vs. 73.4, p<0.0005) and had a lower All Patient Refined Severity of Illness (APRSI) (30-day: p=0.047, 90-day: p=0.004), but had longer lengths of stay at readmission (30-day WAMV of 5.3 vs. 4.3 days, p<0.0005; 90-day WAMV of 5.4 vs. 4.9 days, p<0.0005). However, patients readmitted to OSH had higher rates of multiple readmissions (45.7% vs. 35.4%, p=0.007) and ICU stays (18.7% vs. 12.0%, p=0.002) at 90 days. Patients readmitted to OSH within 30 days of RC were also 3.62 times more likely to die than those readmitted to OH (95% CI 1.53-8.58, p<0.005). Gender, race, APR Risk of Mortality (APRRM), and primary payer were not significantly different between OH and OSH readmissions. CONCLUSIONS Patients readmitted to OSH within 30 days of RC were over 3 times more likely to die than those readmitted to OH. Potential drivers of worse outcomes at OSH are higher acuity of admitting diagnosis, lower quality or fewer resources at OSH, and less familiarity of the hospital staff with the patient. Individual patient analysis is needed to further elucidate the drivers leading to worse outcomes at readmission to OSH vs. OH after RC. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e284 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jamie S. Pak More articles by this author Danny Lascano More articles by this author Daniel Kabat More articles by this author Julia B. Finkelstein More articles by this author Mark V. Silva More articles by this author G. Joel DeCastro More articles by this author William Gold More articles by this author James M. McKiernan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...