MP67-14 WHITE BLOOD CELL COUNT AT DISCHARGE FOLLOWING RADICAL CYSTECTOMY ASSOCIATES WITH RISK FOR READMISSION

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2015MP67-14 WHITE BLOOD CELL COUNT AT DISCHARGE FOLLOWING RADICAL CYSTECTOMY ASSOCIATES WITH RISK FOR READMISSION Philip Abbosh, Timothy Ito, Jason Mannion, Andrew McIntosh, Mark Dziemianowicz, Nikhil Waingankar, Mohammed Haseebuddin, David Chen, Richard Greenberg, Rosalia Viterbo, Alexander Kutikov, Robert Uzzo, and Marc Smaldone Philip AbboshPhilip Abbosh More articles by this author , Timothy ItoTimothy Ito More articles by this author , Jason MannionJason Mannion More articles by this author , Andrew McIntoshAndrew McIntosh More articles by this author , Mark DziemianowiczMark Dziemianowicz More articles by this author , Nikhil WaingankarNikhil Waingankar More articles by this author , Mohammed HaseebuddinMohammed Haseebuddin More articles by this author , David ChenDavid Chen More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Marc SmaldoneMarc Smaldone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2497AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy (RC) is associated with perioperative complication rates exceeding 50% even in highly experienced centers. Readmission rates following RC are non-trivial and have received recent significant attention given their increasing use as a surgical quality metric by healthcare payers. White blood cell count (WBC) is a crude surrogate for inflammatory processes which may associate with different causes of postoperative complications. We assessed whether final WBC (fWBC) was associated with risk for readmission in patients undergoing RC. METHODS Pre- and postoperative clinicopathologic data was extracted from computerized patient records on 477 patients undergoing RC at a single institution from 2006-2013. fWBC was defined as the last documented WBC during the index admission. Significant cutoff values for continuous variables were identified using the recursive partitioning method. Univariate analysis (UVA) was performed using Fisher's exact, Wilcoxon and Spearman's coefficient tests where appropriate. For multivariate analysis (MVA), models were fit using logistic regression. RESULTS In total, 34% of patients were readmitted within 90 days of RC. When examining fWBC amongst this cohort, a cutoff value of 9000/mm3 was identified, with a significantly higher proportion of patients with fWBC > 9000/mm3 experiencing readmission than those with fWBC ≤ 9000/mm3 (42% vs 28%, p=0.004). Other perioperative variables associated with an increased readmission rate included initial hospital length of stay ≤ 10 days (36% vs 26%, p=0.04), continent diversion (51% vs 30%, p<0.0001), and presence of any major (≥Clavien III) complication (62% vs 19%, p<0.0001); however, complications occurring during index admission were not associated with readmission (25% vs 35%, p=0.09). On MVA controlling for significant variables, fWBC > 9000/mm3 remained an independent predictor of readmission post-RC (OR 2.09, 95% CI 1.23-3.53, p=0.006). Continent diversion (OR 2.50, 95% CI 1.21-5.18, p=0.01), shorter initial hospital length of stay (OR 4.03, 95% CI 1.99-8.14, p=0.0001) and presence of a major complication (OR 15.1, 95% CI 7.87-29.0, p<0.0001) also remained significant predictors of readmission. CONCLUSIONS The presence of leukocytosis (fWBC > 9) immediately prior to discharge is an independent predictor of readmission following RC. Use of this readily available clinical metric may afford opportunities to tailor hospital discharge strategies and allow for a more informed triage of cystectomy patients into appropriate outpatient follow-up algorithms. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e855 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philip Abbosh More articles by this author Timothy Ito More articles by this author Jason Mannion More articles by this author Andrew McIntosh More articles by this author Mark Dziemianowicz More articles by this author Nikhil Waingankar More articles by this author Mohammed Haseebuddin More articles by this author David Chen More articles by this author Richard Greenberg More articles by this author Rosalia Viterbo More articles by this author Alexander Kutikov More articles by this author Robert Uzzo More articles by this author Marc Smaldone More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...