MP9-16 NATIONAL MULTI-INSTITUTIONAL CAUSES AND PREDICTORS OF 30-DAY UNPLANNED READMISSION AFTER MAJOR UROLOGIC SURGERY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM.

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 2015MP9-16 NATIONAL MULTI-INSTITUTIONAL CAUSES AND PREDICTORS OF 30-DAY UNPLANNED READMISSION AFTER MAJOR UROLOGIC SURGERY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM. Raffaella DeRosa, Alexander Ernest, Michael Lustik, Joseph Sterbis, and Leah McMann Raffaella DeRosaRaffaella DeRosa More articles by this author , Alexander ErnestAlexander Ernest More articles by this author , Michael LustikMichael Lustik More articles by this author , Joseph SterbisJoseph Sterbis More articles by this author , and Leah McMannLeah McMann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.376AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine the incidence and predictors of 30-day hospital readmission in a large series of patients who underwent non-emergent major urologic surgeries, including nephrectomy, prostatectomy, and cystectomy. METHODS A multi-institutional study was performed using the 2012 National Surgical Quality Improvement Program (NSQIP) database to determine predictors of unplanned 30-day readmission after non-emergent major urologic surgeries. The primary outcome was the development of a complication requiring hospital readmission at ≤30 days after surgery. Predictors were determined using multivariate logistic regression models. RESULTS A total of 21,377 patients who underwent major urologic surgery from 2011–2012 were retrospectively identified from the NSQIP database, and 1,353 (6%) were readmitted within 30 days after surgery. The most common complications in the readmitted cohort included bleeding requiring blood transfusion 357/1,353 (26%), sepsis including shock 212/1,353 (15%), and urinary tract infection 179/1,353 (13%). The most common surgical complication was organ space surgical site infection 112/1,353 (8%). Patients who were readmitted had a significantly higher rate of reoperation as well as Clavien 4 and 5 complications (P<0.001). The reoperation rate for readmitted patients was 14% versus 1% for those not readmitted (P<0.001). The mortality rate was 2% for readmitted patients compared to 0.2% for those not admitted (P<0.001). Statistically significant predictors of 30 day unplanned readmission for all major urologic surgeries included age 50–64 years, ASA classification 3 or 4, disseminated cancer at the time of surgery, renal failure, diabetes requiring medication, steroid use, COPD, and dependent functional status (P<0.001). Patients who underwent cystectomy had the longest postoperative hospital stays with a median of 8 days. Nephrectomy and prostatectomy patients with shorter hospital stays (≤7 days), were less likely to be readmitted. Among patients who were discharged within 3 weeks, patients with longer hospital stays were more likely to be readmitted than those with shorter hospital stays. CONCLUSIONS Using a nationwide validated surgical outcomes database, the overall rate of readmission after major urologic surgery was 6%. Preoperative risk factors including disseminated cancer, renal failure, diabetes, steroid use, COPD, chronic steroid use, and poor functional status are significant predictors of unplanned hospital readmission. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e108 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raffaella DeRosa More articles by this author Alexander Ernest More articles by this author Michael Lustik More articles by this author Joseph Sterbis More articles by this author Leah McMann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...