MP64-12 RISK FACTORS FOR 30-DAY HOSPITAL READMISSION OF ROBOTIC PARTIAL NEPHRECTOMY PATIENTS

Abstract

INTRODUCTION AND OBJECTIVES: Since 2009, Centers for Medicare and Medicaid Services (CMS) began publishing 30-day readmission data for selected medical diseases. The Readmission Reduction Program went into effect on October 1st, 2012 and hospitals are now financially penalized for excess readmissions. The purpose of this study is to identify factors associated with 30-day readmission after robotic partial nephrectomy (RPN). METHODS: We retrospectively reviewed our Institutional ReviewBoard approveddatabase of RPN.Demographics and perioperative parameters were analyzed. Comparisons between both groups were evaluated using Wilcoxon rank-sum test for continuous variables, while chi-square test, or Fisher’s exact test (if events number were small) were used for categorical variables. Simple or multivariable logistic regression analysis was applied to identify factors associated with readmission. Results were considered significant when p value was <0.05. RESULTS: We identified 627 patients who underwent RPN from March 2006 tomarch 2013. Twenty nine patients (4.6%) were readmitted within 30 days. Postoperative bleeding was responsible for 6 (20%) readmissions, followed by pulmonary embolism with 3 cases and retroperitoneal abscess in 2 patients. Moreover, two patients had urine fistula requiring surgical intervention. Other causes of readmission included chest pain (2), pneumonia (2), vomiting (2), deep venous thrombosis (2), ileus (2), pyelonephritis (1), bladder perforation (1), abdominal pain (1), trocar hernia (1), dehydration (1) and wound infection (1). In total, 11 (37.9%) patients presentedwithmajor complications ( Clavien grade 3). When both groups were compared, there was no significant difference in age, bodymass index, tumor size,R.E.N.A.L. score, operative time, blood loss, hospital stay and warm ischemia time. On univariable and multivariable analysis, only Charlson score was found to be significantly associated (p1⁄40.021) with readmission. The chance of readmission increases 57% for Charlson score higher than 4. CONCLUSIONS: Patient‘s health status before the surgery as assessed by the Charlson comorbidity index was the only factor associated with early readmission. Perioperative factors did not have an impact on the 30-day readimission rate.