PD02-03 UNDERLYING REASONS ASSOCIATED WITH HOSPITAL READMISSION FOLLOWING UROLOGIC SURGERY IN THE U.S.

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety I1 Apr 2016PD02-03 UNDERLYING REASONS ASSOCIATED WITH HOSPITAL READMISSION FOLLOWING UROLOGIC SURGERY IN THE U.S. Mark Tyson and Sam Chang Mark TysonMark Tyson More articles by this author and Sam ChangSam Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2077AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Financial penalties for readmission have been expanded beyond medical complications to now include surgical complications. While hospitals are working to reduce readmissions, more information is needed about the reasons for readmission after urologic surgery. METHODS Using NSQIP data, we studied patients undergoing urologic surgery during 2013. Readmissions rates and reasons for readmission were assessed for a full-spectrum of urological procedures. Multivariable logistic regression analysis using a forward selection process was performed to identify variables associated with unplanned readmission. The proportion of variation in outcome attributable to one of four categories of variables generally considered to be explanatory for readmission was assessed using McKelvey & Zavoina's R2 for multilevel logistic regression models (complications during index hospitalization, patient comorbidity, patient demographics, and discharge destination). RESULTS We identified 52,643 urologic surgeries with an unplanned readmission rate of 5.8% (n=3,040). For individual procedures, the readmission rate ranged from 1.4% for urethroplasty to 21.6% for radical cystectomy. The most common reason for unplanned readmission was surgical site infection or urinary tract infections (22%), ileus/bowel obstruction (9%), sepsis (6%), and bleeding/anemia (5%). Increasing age (OR: 1.01 [95% CI: 1.00, 1.01]; P<0.01), male gender (1.23 [1.12, 1.34]; p<0.01), black race (1.26 [1.10, 1.45]; p<0.01), increasing ASA class (1.63 [1.35, 1.97]; p<0.01), underweight BMI (1.24 [1.01, 1.53]; p=0.04), CHF (1.76 [1.20, 2.58]; p<0.01), disseminated cancer (1.52 [1.28, 1.81]; p<0.01), bleeding disorder (1.31 [1.08, 1.60]; p<0.01), steroid use (1.68 [1.41, 2.00]; p<0.01), and index hospital complications (p<0.01 for each) was associated with unplanned readmission after urologic surgery. Discharge to a skilled care facility was protective (0.60 [0.48, 0.75]; p<0.01). Complications during the index hospitalization accounted for most of the variation in risk of unplanned readmission (R2=0.16). CONCLUSIONS Unplanned readmission after urologic surgery was most closely associated with complications from the index hospitalization as compared to patient comorbidity, demographics, and discharge destination. These data should be considered when developing quality indicators and any policies penalizing hospitals for surgical readmission. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e51 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Mark Tyson More articles by this author Sam Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...