PD10-09 HEALTH CARE DISPARITIES AND POST DISCHARGE COMPLICATIONS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III1 Apr 2016PD10-09 HEALTH CARE DISPARITIES AND POST DISCHARGE COMPLICATIONS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY David M. Golombos, Padraic O'Malley, Patrick Lewicki, Bashir Al Hussein Al Awamlh, Daniel P. Nguyen, Igor Inoyatov, and Douglas S. Scherr David M. GolombosDavid M. Golombos More articles by this author , Padraic O'MalleyPadraic O'Malley More articles by this author , Patrick LewickiPatrick Lewicki More articles by this author , Bashir Al Hussein Al AwamlhBashir Al Hussein Al Awamlh More articles by this author , Daniel P. NguyenDaniel P. Nguyen More articles by this author , Igor InoyatovIgor Inoyatov More articles by this author , and Douglas S. ScherrDouglas S. Scherr More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2917AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Health disparities linked to socioeconomic status (SES) have demonstrated association with patient outcomes and complications. We hypothesized that in a diverse urban population, lower SES would be associated with peri-operative morbidity and post-discharge complications after radical cystectomy. METHODS IRB approved, retrospective chart review was performed on 383 non-metastatic patients who underwent definitive radical cystectomy at a single tertiary care center between 2001-2014. Along with selected clinical and pathologic parameters traditionally used for pre-operative risk stratification, potential social determinants of health, such as median household income and rates of completed high school education were gathered using patient zip codes and US Census data. Post-operative complications were defined using the standardized Clavien-Dindo classification. After dividing patients into tertiles based on SES parameters, potential differences were assessed using Wilcox rank-sum testing. Multivariable logistic regression was then performed to identify predictors of complication. A p=0.05 was considered as significant. RESULTS After 20 international patients were excluded, 363 patients were analyzed. Patients with the lowest education levels were at higher risk for any complication within 90 days (P=0.004). Both low level of education (p=0.038) and low household median income (p=0.037) increased patient risk of post-discharge complication within 90 days. On multivariable logistic regression, education level (OR, 0.64 [95% CI, 0.46-0.89] p=0.007), household income (OR, 0.64 [95% CI, 0.19-0.92] p=0.031), and length of stay (OR, 1.13 [95% CI, 1.08-1.19] p=<0.001) were significantly associated with any complication. ASA classification approached, but did not achieve significance (p=0.072). Furthermore, education level (OR, 0.64 [95% CI, 0.46-0.89] p=0.008) and household income (OR, 0.42 [95% CI,0.19-0.96] p=0.039) were associated with post-discharge 90 day complication, with ASA classification (p=0.07) and nodal involvement (p=0.08) approaching significance. CONCLUSIONS Patients with lower socioeconomic status, indicated by lower median household income and education level, appear to be at increased risk of post-operative complication after radical cystectomy, especially once discharged from the hospital. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e242 Advertisement Copyright & Permissions© 2016MetricsAuthor Information David M. Golombos More articles by this author Padraic O'Malley More articles by this author Patrick Lewicki More articles by this author Bashir Al Hussein Al Awamlh More articles by this author Daniel P. Nguyen More articles by this author Igor Inoyatov More articles by this author Douglas S. Scherr More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...