PD51-02 SOCIAL DETERMINANTS OF HEALTH ASSOCIATED WITH INCREASED READMISSIONS TO NON-INDEX HOSPITALS

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III (PD51)1 Sep 2021PD51-02 SOCIAL DETERMINANTS OF HEALTH ASSOCIATED WITH INCREASED READMISSIONS TO NON-INDEX HOSPITALS Valentina Grajales, Jonathan Y. Lin, Adam J. Sharbaugh, Michelle Yu, Dan Pelzman, Zhaojun Sun, Maria M. Pere, Jonathan G. Yabes, Benjamin J. Davies, Lindsay M. Sabik, and Bruce L. Jacobs Valentina GrajalesValentina Grajales More articles by this author , Jonathan Y. LinJonathan Y. Lin More articles by this author , Adam J. SharbaughAdam J. Sharbaugh More articles by this author , Michelle YuMichelle Yu More articles by this author , Dan PelzmanDan Pelzman More articles by this author , Zhaojun SunZhaojun Sun More articles by this author , Maria M. PereMaria M. Pere More articles by this author , Jonathan G. YabesJonathan G. Yabes More articles by this author , Benjamin J. DaviesBenjamin J. Davies More articles by this author , Lindsay M. SabikLindsay M. Sabik More articles by this author , and Bruce L. JacobsBruce L. Jacobs More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002078.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy is associated with one of the highest readmission rates of any surgery, hovering around 25%. Readmissions occur both at the hospital at which patients received their surgery (index readmission) and at other hospitals (non-index readmission). Non-index readmissions have been associated with worse outcomes. We sought to examine characteristics associated with being readmitted to a non-index hospital. METHODS: Using the Pennsylvania Cancer Registry linked to the Pennsylvania Health Care Cost Containment Council database, we identified all patients with non-metastatic muscle-invasive bladder cancer between 2010-2016 who were treated with radical cystectomy. The primary outcome was readmission to an index versus non-index hospital. We fit a multivariable logistic regression model to assess predictors of being readmitted to a non-index hospital, adjusting for several patient demographic and clinical characteristics. Area Deprivation Index (ADI) was used as a surrogate for socioeconomic status and reported as quartiles. The 4th quartile represents the lowest socioeconomic status. Urban, large town and rural residence was defined using the Rural-Urban Commuting Area codes. RESULTS: We identified 2,113 patients with muscle-invasive bladder cancer who underwent radical cystectomy. Of those, 517 (24.5%) patients were readmitted within 30 days. Non-index readmissions accounted for 86 (4%) of these patients. Patients who had higher comorbidity burden, positive N stage and rural residence were significantly associated with higher non-index readmissions. On multivariable analysis, high comorbidity index (odds ratio [OR] 3.22) and rural residence (OR 4.28) were independent predictors of non-index readmissions (all p<0.05). CONCLUSIONS: Rural residence and high comorbidity burden were predictors of readmissions to non-index hospitals after radical cystectomy while insurance and socioeconomic status were not. Metastatic disease was also associated with increased non-index readmissions. Development of policy initiatives may help assess disparities in rural residence and healthcare access. Source of Funding: Valentina Grajales, MD, MS was supported in part by the 2020 Urology Care Foundation Residency Research Award Program and The Kahlert FoundationBruce L. Jacobs, MD MPH is supported in part by the Shadyside Hospital Foundation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e905-e905 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Valentina Grajales More articles by this author Jonathan Y. Lin More articles by this author Adam J. Sharbaugh More articles by this author Michelle Yu More articles by this author Dan Pelzman More articles by this author Zhaojun Sun More articles by this author Maria M. Pere More articles by this author Jonathan G. Yabes More articles by this author Benjamin J. Davies More articles by this author Lindsay M. Sabik More articles by this author Bruce L. Jacobs More articles by this author Expand All Advertisement Loading ...