Procedure-related Readmission Research Articles

Procedure-related readmissions following endoscopic retrograde cholangiopancreatography in a liver transplant cohort.

Data on post-endoscopic retrograde cholangiopancreatography (ERCP) adverse events and readmission rates in liver transplantation (LT) patients remain scarce. This study determined the 30-day procedure-related readmission rate following ERCP in an LT cohort at an Australian tertiary academic center. All unplanned readmissions within 30 days following ERCP in orthotopic LT patients between December 2012 and August 2021 were retrospectively identified. Demographic data, procedure variables, and readmission characteristics were also collected. Forty-five procedure-related readmissions were identified (3.3%) from a total of 1369 ERCP procedures. This included 33 cases of cholangitis (2.4%), 7 cases of nonspecific abdominal pain (0.5%), 5 cases of mild post-ERCP pancreatitis (0.5%), and 3 cases of bleeding (0.2%). No procedure-related mortality was observed. The procedure-related readmission rate following ERCP in this LT cohort was 3.3%, which is likely lower than comparable studies carried out on the overall population.

Cost analysis of open versus robot-assisted ventral hernia repair – a retrospective cohort study

BackgroundRobot-assisted ventral hernia repair is associated with decreased length of stay and lower complication rates compared with open repair, but acquisition and maintenance of the robotic system is costly. The aim of this was study was to compare the procedure-specific cost of robot-assisted and open ventral and incisional hernia repair including cost of procedure-related readmissions and reoperations within 90 days postoperatively.MethodsSingle-center retrospective cohort study of 100 patients undergoing robot-assisted ventral hernia. Patients were propensity-score matched 1:1 with 100 patients undergoing open repairs on age, type of hernia (primary/incisional), and horizontal defect size. The primary outcome of the study was the total cost per procedure in Euros including the cost of a robotic approach, extra ports, mesh, tackers, length of stay, length of readmission, and operative reintervention. The cost of the robot itself was not included in the cost calculation.ResultsThe mean length of stay was 0.3 days for patients undergoing robot-assisted ventral hernia repair, which was significantly shorter compared with 2.1 days for patients undergoing open repair, P < 0.005. The readmission rate was 4% for patients undergoing robot-assisted ventral hernia repairs and was significantly lower compared with open repairs (17%), P = 0.006. The mean total cost of all robot-assisted ventral and incisional hernia repairs was 1,094 euro compared with 1,483 euro for open repairs, P = 0.123. The total cost of a robot-assisted incisional hernia repair was significantly lower (1,134 euros) compared with open ventral hernia repair (2,169 euros), P = 0.005.ConclusionsIn a Danish cohort of patients with incisional hernia, robot-assisted incisional hernia repair was more cost-effective than an open repair due to shortened length of stay, and lower rates of readmission and reintervention within 90 days.

EUS-guided versus percutaneous liver abscess drainage: A multicenter collaborative study.

Management of hepatic abscesses has traditionally been performed by image-guided percutaneous techniques. More recently, EUS drainage has been shown to be efficacious and safe. The aim of this study is to compare EUS-guided versus percutaneous catheter drainage (PCD) of hepatic abscesses. Patients who underwent EUS-guided drainage or PCD of hepatic abscesses from January 2018 through November 2021 from 4 international academic centers were included in a dedicated registry. Demographics, clinical data preprocedure and postprocedure, abscess characteristics, procedural data, adverse events, and postprocedure care were collected. Seventy-four patients were included (mean age, 63.9 years; 45% male): EUS-guided (n = 30), PCD (n = 44). Preprocedure Charlson Comorbidity Index scores were 4.3 for the EUS group and 4.3 for the PCD group. The median abscess size was 8.45 × 6 cm (length × width) in the EUS group versus 7.3 × 5.5 cm in the PCD group. All of the abscesses in the EUS group were left-sided, whereas the PCD group contained both left- and right-sided abscesses (29 and 15, respectively). Technical success was 100% in both groups. Ten-millimeter-diameter stents were used in most cases in the EUS group, and 10F catheters were used in the PCD group. The duration to resolution of symptoms from the initial procedure was 10.9 days less in the EUS group compared with the PCD group (P < 0.00001). Hospital length of stay was shorter in the EUS group by 5.2 days (P = 0.000126). The EUS group had significantly fewer number of repeat sessions: mean of 2 versus 7.7 (P < 0.00001) and trended toward fewer number of procedure-related readmissions: 10% versus 34%. The PCD group had a significantly higher number of adverse events (n = 27 [61%]) when compared with the EUS group (n = 5 [17%]; P = 0.0001). EUS-guided drainage is an efficacious and safe intervention for the management of hepatic abscesses. EUS-guided drainage allows for quicker resolution of symptoms, shorter length of hospital stay, fewer adverse events, and fewer procedural sessions needed when compared with the PCD technique. However, EUS-guided drainage may not be feasible in right-sided lesions.

A comparison of open or laparoscopic colectomy outcomes for the management of ischemic colitis using the ACS-NSQIP database

Ischemic colitis is a common manifestation of intestinal ischemia and is potentially a surgical emergency. Although such surgical emergencies were historically approached via open exploration, it is uncertain if there is a role for minimally invasive techniques. This study compares open vs laparoscopic colectomy techniques in the management of ischemic colitis. Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, patients with ischemic colitis undergoing colectomy from 2005 to 2019 were compared. The primary outcome of interest was 30-day mortality. Additional outcomes of interest were procedure related readmission, procedure related reoperation, length of stay, surgical site infections (SSI), septic shock, and other complications. Outcomes of interest were compared using multivariate logistic regression. 7,928 patients had ischemic colitis with 7,209 undergoing open colectomy and 719 undergoing laparoscopic colectomy. The mortality rate was significantly lower using a laparoscopic approach compared to open (6.4% vs 26%, p=<0.001) and associated with a lower odd of mortality (OR 0.58; 95% CI [0.35, 0.95]). Procedure related reoperation was lower in the laparoscopic group (6.5% vs 11%, p<0.001), but multivariate analysis was not significant (OR 0.65; 95% CI [0.43,1]). Readmission rates were not statistically different (12% vs 10%, p = 0.2). Postoperative length of stay (7 vs 12 days, p=<0.001), septic shock (6.7% vs 27%, p=<0.001), and organ space SSI (3.2% vs 6.9%, p=<0.001) were significantly decreased using a laparoscopic approach. 30-day postoperative mortality was significantly lower using a laparoscopic. Patients that had a laparoscopic colectomy had shorter hospital stays. While patients that underwent laparoscopic procedures tended to be less sick, multivariate analysis showed decreased rates of sepsis and surgical site infections compared to open colectomies when correcting for these factors. Laparoscopic colectomy may be a better surgical approach for patients with ischemic colitis compared to open colectomy.

MP70-06 MATCHED ANALYSIS OF URINARY TRACT INFECTIONS AND READMISSIONS AFTER OPEN URETERONEOCYSTOSTOMY: DOES AGE MATTER?

You have accessJournal of UrologyCME1 Apr 2023MP70-06 MATCHED ANALYSIS OF URINARY TRACT INFECTIONS AND READMISSIONS AFTER OPEN URETERONEOCYSTOSTOMY: DOES AGE MATTER? Abraham Almatari, Khaled Aldabek, Gerald Jerkins, Dana Giel, Amr Mahran, and Mary Killian Abraham AlmatariAbraham Almatari More articles by this author , Khaled AldabekKhaled Aldabek More articles by this author , Gerald JerkinsGerald Jerkins More articles by this author , Dana GielDana Giel More articles by this author , Amr MahranAmr Mahran More articles by this author , and Mary KillianMary Killian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The effect of age on the outcomes of Vesicoureteral Reflux (VUR) surgery is not well studied. Our hypothesis is that older children are at higher risk of complications and readmissions following open ureteroneocystostomy (UNC) as they are more prone to voiding dysfunction. Our objective is to study the rates and predictors of the 30-day post-operative urinary tract infection (poUTI) and readmissions after UNC among children younger and older than the age of 3. METHODS: The ACS pediatric National Surgical Quality Improvement Program (NSQIP-P) between 2012–2020 was queried for open UNC CPT codes 50780 and 50782. Only vesicoureteral reflux patients were included. Patients with severe comorbities and unknown ASA class/prematurity were excluded. Propensity score matching (PSM) was performed in a 1:1 ratio to nearest matching (> 3 years “older group” versus≤3 years “younger group”). Multivariable regression analyses were performed on the matched set for poUTI and procedure-related readmission. Database limitations included the lack of information regarding the degree of VUR, prior VUR procedures, and preoperative urine culture results. All analyses were performed utilizing R 4.1.2. RESULTS: 6552 patients were identified including 2749 and 3803 patients in the younger and the older groups; respectively. After PSM, 2383 patients were included in each group. There were no statistical differences among the baseline characteristics and the operative time across the matched groups. The rate of poUTI and procedure-related readmissions were significantly higher in the younger patients as compared to the older group either before or after PSM as seen in Table 1 (all; p<0.001). On multivariable analysis, younger patients had higher odds of poUTI (adjusted odds ratio (aOR): 1.92, 95% confidence interval (CI): 1.35-2.72, p<0.001) as well as higher odds of procedure-related readmissions (aOR: 2.42, 95% CI: 1.72-3.40, p<0.001) CONCLUSIONS: Three-year old children or younger were at increased risk of UTI and procedure-related readmissions after open UNC for VUR when compared to older patients. Study results should be interpreted with caution given the database limitations. Further validation of the current study findings is warranted. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1005 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abraham Almatari More articles by this author Khaled Aldabek More articles by this author Gerald Jerkins More articles by this author Dana Giel More articles by this author Amr Mahran More articles by this author Mary Killian More articles by this author Expand All Advertisement PDF downloadLoading ...

Readmission rate and complications following biopsy of the ampulla of Vater-A retrospective data analysis.

Obtaining endoscopic biopsies from the ampulla of Vater is important for the diagnosis of lesions that are suspicious for neoplasia. The clinical safety profile is not well defined in the literature. Our aim was to evaluate the procedure-related readmission rate and complications from ampullary biopsy in patients undergoing duodenoscopy and endoscopic retrograde cholangiopancreatography (ERCP). A retrospective data analysis was performed on adult patients at Austin Hospital who underwent ampullary biopsies between 1 January 2010 and 1 March 12022. Medical records were identified using pathology databases. The electronic health record was reviewed for baseline characteristics including demographics, date, indication for ampullary biopsy, procedure type (duodenoscopy or ERCP), and procedural associated interventions during ERCP. Readmissions to the Austin Emergency Department within 30 days following the biopsy were identified, and complications were noted. A total of 506 records were reviewed and 246 episodes of ampullary biopsy met the inclusion criteria. The procedure-related readmission rate for all episodes was 6.1%, which included pain (3.3%), pancreatitis (2.0%), cholangitis (1.6%), and bleeding (0.8%). Ampullary biopsies with ERCP had a procedure-related readmission rate of 8.4%, whereas ampullary biopsies without ERCP had a rate of 2.2%. Increased readmissions and complications were associated with male sex (P = 0.01 and P = 0.05, respectively). There was no association between the number of biopsies taken and complications. Performing an ampullary biopsy without an associated ERCP carries a low rate of clinical complications and procedure-related readmissions. The combination of ERCP and ampullary biopsy increases the risk four-fold.

26. Occluding annular defects with a bone anchored closure device results in fewer procedure related readmissions after lumbar discectomy: Four-year data from a multicenter, prospective, randomized superiority study

<h3>BACKGROUND CONTEXT</h3> Lumbar discectomy is typically successful in reducing pain and neurological dysfunction when conservative treatment fails; however, approximately 30% of patients experience readmissions from device- or procedure-related serious adverse events. Large defects (≥ 6 mm wide) in the annulus fibrosis are a significant risk factor for readmission. Early results with occluding such defects with an annular closure device (ACD) have been promising in reducing readmission rates, but long-term outcomes have not been reported. <h3>PURPOSE</h3> To examine the readmission rates of the randomized, prospective, multicenter trial at 4 years. <h3>METHODS</h3> Primary discectomy patients at 21 sites were randomized intraoperatively 1:1 for treatment with discectomy alone (control, 278 patients) or discectomy followed by the ACD (272 patients). Inclusion criteria included 6 weeks conservative care, minimum Oswestry Disability Index (ODI) and visual analog scale (VAS) for leg pain scores (40/100), 5 mm minimum posterior disc height, and an intraoperatively measured annular defect width of 6-10 mm. Readmissions were identified as device- or procedure-related SAEs, as adjudicated by 4 clinicians. Survival analysis and univariate Cox regression using all participants were used to calculate readmission rates and hazard ratios (HRs) of demographic factors, respectively. <h3>RESULTS</h3> A total of 463 of 550 subjects (84.2%) was assessed at 4 years: 229 of 278 (82.4%) control and 234 of 272 (86.0%) ACD. The overall readmission rates for the control and ACD groups were 19.8% and 12.2%, respectively (p = 0.0099, log-rank test). ACD deficiency was observed in 11 subjects (4.0%). Reherniation at the index level occurred in 46 (16.5%) control and 18 (6.6%) ACD participants (p < 0.001, Fisher's exact test). HRs of age, gender, operative level, body mass index and current smoking status were calculated for each treatment arm. Notably, statistically significant readmission HRs for current smokers were 1.93 and 2.4 in control and ACD groups, respectively, whereas the HR for females in the control group was 1.97. <h3>CONCLUSIONS</h3> Occluding annular defects ≥ 6 mm by augmenting lumbar discectomy with an ACD reduced readmission by 38.4% at 4 years, primarily due to a reduction in reherniation at the index level. Female gender and smoking were risk factors for readmission. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

NarxCare Scores Greater Than 300 Are Associated with Adverse Outcomes After Primary THA.

The association between preoperative prescription drug use (narcotics, sedatives, and stimulants) and complications and/or greater healthcare utilization (length of stay, discharge disposition, readmission, emergency department visits, and reoperation) after total joint arthroplasty has been established but not well quantified. The NarxCare score (NCS) is a weighted scalar measure of overall prescription opioid, sedative, and stimulant use. Higher scores reflect riskier drug-use patterns, which are calculated based on (1) the number of prescribing providers, (2) the number of dispensing pharmacies, (3) milligram equivalence doses, (4) coprescribed potentiating drugs, and (5) overlapping prescription days. The aforementioned factors have not been incorporated into association measures between preoperative prescription drug use and adverse events after THA. In addition, the utility of the NCS as a scalar measure in predicting post-THA complications has not been explored. (1) Is the NarxCare score (NCS) associated with 90-day readmission, reoperation, emergency department visits, length of stay, and discharge disposition after primary THA; and are there NCS thresholds associated with a higher risk for those adverse outcomes if such an association exists? (2) Is there an association between the type of preoperative active drug prescription and the aforementioned outcomes? Of 3040 primary unilateral THAs performed between November 2018 and December 2019, 92% (2787) had complete baseline information and were subsequently included. The cohort with missing baseline information (NCS or demographic/racial determinants; 8%) had similar BMI distribution but slightly younger age and a lower Charlson Comorbidity Index (CCI). Outcomes in this retrospective study of a longitudinally maintained institutional database included 90-day readmissions (all-cause, procedure, and nonprocedure-related), reoperations, 90-day emergency department (ED) visits, prolonged length of stay (> 2 days), and discharge disposition (home or nonhome). The association between the NCS category and THA outcomes was analyzed through multivariable regression analyses and a confirmatory propensity score-matched comparison based on age, gender, race, BMI, smoking status, CCI, insurance status, preoperative diagnosis, and surgical approach, which removed significant differences at baseline. A similar regression model was constructed to evaluate the association between the type of preoperative active drug prescription (opioids, sedatives, and stimulants) and adverse outcomes after THA. After controlling for potentially confounding variables like age, gender, race, BMI, smoking status, CCI, insurance status, preoperative diagnosis, and surgical approach, an NCS of 300 to 399 was associated with a higher odds of 90-day all-cause readmission (odds ratio 2.0 [95% confidence interval 1.1 to 3.3]; p = 0.02), procedure-related readmission (OR 3.3 [95% CI 1.4 to 7.9]; p = 0.006), length of stay > 2 days (OR 2.2 [95% CI 1.5 to 3.2]; p < 0.001), and nonhome discharge (OR 2.0 [95% CI 1.3 to 3.1]; p = 0.002). A score of 400 to 499 demonstrated a similar pattern, in addition to a higher odds of 90-day emergency department visits (OR 2.2 [95% CI 1.2 to 3.9]; p = 0.01). After controlling for potentially confounding variables like age, gender, race, BMI, smoking status, CCI, insurance status, preoperative diagnosis, and surgical approach, we found no clinically important association between an active opioid prescription and 90-day all-cause readmission (OR 1.002 [95% CI 1.001 to 1.004]; p = 0.05), procedure-related readmission (OR 1.003 [95% CI 1.001 to 1.006]; p = 0.02), length of stay > 2 days (OR 1.003 [95% CI 1.002 to 1.005]; p < 0.001), or nonhome discharge (OR 1.002 [95% CI 1.001 to 1.003]; p = 0.019); the large size of the database allowed us to find statistical associations, but the effect sizes are so small that the finding is unlikely to be clinically meaningful. A similarly small association that is unlikely to be clinically important was found between active sedative use and 90-day ED visits (OR 1.002 [95% CI 1.001 to 1.004]; p = 0.02). Preoperative prescription drug use, as reflected by higher NCSs, has a dose-response association with adverse outcomes after THA. Surgeons may use the preoperative NCS to initiate and guide a patient-centered discussion regarding possible postoperative risks associated with prescription drug-use patterns (sedatives, opioids, or stimulants). An interdisciplinary approach can then be initiated to mitigate unfavorable patterns of prescription drug use and subsequently lower patient NCSs. However, given its nature and its reflection of drug-use patterns rather than patients' current health status, the NCS does not qualify as a basis for surgical denial or ineligibility. Level III, diagnostic study.

Risk factors, causes, and rates associated with hospital readmission after pediatric neck mass surgery

BackgroundTo understand rates, risk factors, and costs associated with hospital readmission in pediatric patients who underwent neck mass excision. MethodsThis was a retrospective review of the Nationwide Readmissions Database (NRD) between 2010 and 2014 of select neck mass procedures, defined as affecting the following: thyroid, salivary gland, cervical lymph nodes, branchial cleft, thymus, and head and neck vessels. We analyzed rates and causes of 30-day readmissions using univariate and multivariate logistic regression. ResultsThere were a total of 11,824 weighted cases identified with a 30-day readmission rate of 9.0% and a mean age of 9.5 years old. The sex distribution of patients undergoing neck mass procedures was 55.8% female and 44.2% male. The most common cause of readmission was associated with a comorbid condition likely unrelated to the neck mass procedure (53%). The most common procedure-related readmission causes were associated with a postoperative neck mass (14.4%), wound (13%), and infection (6.5%). In the multivariate model, number of procedures≥5 (OR: 2.11, 95% CI: 1.28–3.49), number of chronic conditions≥1 (OR: 2.33, 95% CI: 1.16–4.66), length of hospital stay of≥7 days (OR: 2.43, 95% CI: 1.48–0.3.98), and cervical lymph node procedure (OR:2.61, 95% CI: 1.47–4.63) were associated with higher readmission risk. ConclusionReadmission after surgery for pediatric neck masses is relatively common, with an average of 9.0%. Risk factors associated with readmission include length of initial hospital stay, number of chronic conditions, number of procedures performed, and undergoing a cervical lymph node procedure.

Mental illnesses among patients undergoing elective anterior cervical discectomy and fusion: Analysis from the National Readmissions Database

ObjectivePatients with a comorbid mental illness have been observed to have worse outcomes following surgery. However, little is known about the effects of mental disorders on patient outcomes following spinal surgery. In the current study, we sought to investigate the characteristics of patients with mental illness, particularly anxiety, major depressive disorder, concurrent anxiety and schizophrenia, and the impact of these comorbid conditions on outcomes of patients undergoing anterior cervical discectomy and fusion (ACDF) using a national administrative database. Patients and methodsThe National Readmissions Database (NRD) was queried for patients undergoing an ACDF between 2012 and September 30th, 2015. The presence of anxiety, major depressive disorder, concurrent anxiety and schizophrenia were captured using International Classification of Diseases, Ninth Revision (ICD-9) codes. Multivariable logistic regression was used to establish an association between a mental comorbidity and risk of 30- and 90- day readmission. ResultsA total of 139,877 patients undergoing elective ACDF between 2012–2015 were identified, of which 15,927 (11.39 %) had anxiety, 514 (0.38 %) had major depressive disorder, 248 (0.18 %) had concurrent anxiety and major depressive disorder, and 287 (0.21 %) had schizophrenia. Upon multivariable analysis of procedural related readmissions, adjusting for an array of patient and hospital related factors, patients with schizophrenia, compared to controls, had a significantly higher risk of 30-day readmission (OR 2.62, 95 %CI 1.42–4.84, p = 0.002); moreover, schizophrenia (OR = 1.92, 95 % CI 1.13–3.25, p = 0.016) anxiety (OR = 1.13, 95 %CI 1.02–1.26, p = 0.023) were also associated with significantly higher risk of 90-day readmission. ConclusionOur analysis indicates that mental illness comorbidities may be associated with increased rates of procedure related readmission and longer length of stay following elective ACDF.

Safety of Same Day Discharge after Atrial Fibrillation Ablation.

It is routine practice to observe patients (pts) overnight in the hospital after atrial fibrillation (AF) ablation. We report single center experience comparing the rate of complications prior to and after implementing a strategy of same day discharge (SDD) following AF ablation. To assess the safety of SDD after AF ablation. We reviewed the charts of consecutive pts who underwent AF ablation between Jan 2005 to Dec 2015. Patients who were electively admitted to undergo AF ablation or left atrial flutter ablation (AFL) were included. Patients undergoing only right atrial flutter ablation and in-patients were excluded. In Sept 2012 SDD strategy was implemented. Complication rates were collected up to 3 months post ablation. Major complications were defined as death, pericardial tamponade, CVA, hematoma requiring intervention, pulmonary vein stenosis, diaphragmatic paralysis or atrioesophageal fistula formation. Minor complications were defined as hematoma not requiring intervention and procedure related readmissions. Comparisons were made using an intention to treat analysis. Group A (between Jan 2005 to Feb 2010) included 145 patients (87 males; 60.2 yrs mean age; 103 paroxysmal AF) who were observed overnight. Group B (between Mar 2010 to Dec 2015) included 426 patients (298 males; 62.3 yrs mean age; 247 paroxysmal AF) undergoing ablation following implementation of the SDD strategy. Patients in Group B were contacted by phone next day. In Group B, 51/426 (12%) pts were not discharged same day due to non-ablation related medical care (15/50 pts), ablation related complications (17/50 pts), pt preference (14/50 pts) and late cases (5/50 pts). Rate of total complications was more frequent in Group A (Group A 11.7% vs Group B 4.4%; p 0.026). Major complications happened in 2 pts in Group A and 6 pts in Group B. None of the major complications in Group B happened within 24 hrs of discharge. Only one pt in Group B had pericardial effusion drained 10 days post procedure. Most common minor complication in Group A was hematoma not requiring intervention and Group B was procedure related readmissions. Our data suggest that SDD after AF or AFL ablation can be safely implemented in majority of pts with similar outcomes as pts observed overnight.

Epidural Anesthesia is Associated With Increased Complications in Cystectomy Patients: A NSQIP Analysis

ObjectiveTo identify differences in short-term outcomes and readmission rates in cystectomy patients managed with general anesthesia compared to those undergoing general anesthesia and adjuvant epidural anesthesia. MethodsUtilizing the National Surgical Quality Inpatient Program database, patients who underwent a cystectomy with ileal conduit between 2014 and 2017 were included. Patients were further subdivided based on additional anesthesia modality; general anesthesia vs general anesthesia plus epidural anesthesia. Propensity score-matching was used to adjust for baseline differences between cohorts using 1:1 caliper width of 0.15 for the propensity score through the nearest neighbor. Stepwise multivariable logistic regression was used to identify preoperative and intraoperative predictors associated with 30-day procedure related readmission, complications, and length of stay. ResultsAbout 2956 patients met our inclusion and exclusion criteria and eligible for propensity score matching. Compared to general anesthesia, adjuvant epidural anesthesia showed an increased odds of procedure related complications (adjusted Odds Ratio (aOR): 1.264, 95% CI: 1.019-1.567, P = .033). There was an increased trend for development of pulmonary emboli (13 [1.8%] vs 4 [0.5%], P = .051) in the adjuvant epidural cohort. Combined general with epidural anesthesia demonstrated no difference in length of stay, readmission, or reoperation rate in comparison to general anesthesia alone. ConclusionCystectomy patients who underwent general anesthesia plus epidural anesthesia demonstrated a higher percentage of any procedural related complication without change in postoperative stay, reoperation rate, or readmission rate compared to patients undergoing general anesthesia alone.

Is there a benefit to additional neuroaxial anesthesia in open nephrectomy? A prospective NSQIP propensity score analysis.

Neuroaxial (i.e., spinal, regional, epidural) anesthesia has been shown to be associated with reduced readmission rate, decreased hospital stay, and decreased overall complication rate in orthopedic and gynecologic surgery. Our aim was to identify differences in intra- and postoperative complications, length of stay and readmission rates in open nephrectomy patients managed with neuroaxial anesthesia. Utilizing National Surgical Quality Inpatient Program (NSQIP) database, we identified patients who have undergone an open nephrectomy between 2014 and 2017. Patients were further subdivided based on anesthesia modality. We used the propensity score-matching (PSM) method to adjust for baseline differences among patients who received general anesthesia alone and those with additional neuroaxial anesthesia. Using step-wise multivariable logistic regression, we identified preoperative and intraoperative predictors associated with 30-day procedure-related readmission, complications, and postoperative length of stay. Out of 3,633 patients identified, 2346 patients met our inclusion and exclusion criteria. There was no difference in baseline characteristics after propensity score matching between general and additional neuroaxial anesthesia. Postoperative outcomes including: procedure-related readmission, rate of reoperation, operative time, all complications were similar between the groups. Adjuvant neuroaxial anesthesia group did experience a prolonged postoperative hospital stay that was statistically significant as compared to patients with general anesthesia alone [5.3 (3.5) days vs 4.8 (2.9) days, p = 0.007]. Compared to GA alone after multivariable logistic regression, neuroaxial anesthesia was not statistically significant for readmission (p = 0.909), any complication (p = 0.505), but did showed increased odds ratio of prolonged postoperative stay [aOR 1.107, 95% CI 1.042-1.176, p = 0.001] after adjusting for multiple factors. Using 2014-2017 NSQIP database, we were able to demonstrate no additional reduction in complication or readmission rate in patients with neuroaxial anesthesia as compared to general anesthesia alone. Furthermore, patients who did receive neuroaxial anesthesia experienced a longer postoperative course.

Comparison of 30-day postoperative outcomes of open and minimally invasive pyeloplasty utilizing the prospective National Surgical Quality Improvement Program-Pediatric database

Open pyeloplasty (OP) has traditionally been the standard for the operative management of ureteropelvic junction obstruction in children. With advances in minimally invasive pyeloplasty (MIP) techniques, it is quickly becoming a popular alternative in both adult and pediatric population. To evaluate the differences in outcomes between MIPand OPfor the surgical correction of ureteropelvic junction obstruction in children. Data were obtained from the pediatric National Surgical Quality Improvement Program 2012-2017. We identified 1280 patients who underwent MIP and 1190 patients who underwent OP between 2012 and 2017. Propensity score matching was utilized to adjust for baseline differences. Univariate and multivariable regression were performed to assess odds of complications and procedure-related readmission. Patients who underwent OP had a significantly decreased operative time (192.42 vs 142.00min, p<0.001) compared to MIP. There was no significant difference in the rates of overall peri-operative complications (3.7% [MIP] vs 2.4% [OP] p=0.397). On multivariable analysis, patients undergoing OP had a lower risk of procedure-related readmission (odds ratio [OR] 0.404, 95% confidence interval [CI] 0.157-0.951, p=0.046) than MIP. In a multivariable linear regression model, the risk of having any postoperative complication, regardless of surgical approach, decreased with increasing patient age (OR 0.945, 95% CI 0.893-0.996, p=0.037). Although recent small, retrospective institutional studies have found decreased hospitalization time of MIP as compared to OP, in our large prospective database, we found no such association. While some studies suggest a higher rate of wound complications in the OP group, this was not reproduced in our study as well. MIP was, in fact, associated with higher rate of readmissions as compared to the OP group, which may act as a surrogate of long-term complications in these patients. MIP offers an alternative to OP in the pediatric population with similar rates of peri-operative complications. However, our study shows decreased odds of procedure-related readmission in OP, which may serve as a surrogate for less postoperative complications in these patients.

Cataract Surgery Complications and Revisit Rates Among Three States

To characterize population-based 30-day procedure-related readmissions (revisits) following cataract surgery. Ambulatory cataract surgery performed in California, Florida, or New York. Retrospective cohort study. This study used all-capture state administrative datasets. Cataract procedures from California, Florida, and New York state ambulatory surgery settings were identified using ICD-9-CM and CPT codes. Thirty-day readmissions (revisits) were identified in inpatient, ambulatory, and emergency department settings across each state. Across the 3 states, the all-cause 30-day readmission rate was 6.0% and the procedure-related readmission (revisit) rate was 1.0%. Procedure-related revisits were highest for patients aged 20-29 (2.9%) and 30-39 (2.3%) and lowest for patients aged 70-79 (0.9%). Multivariate associations between clinical characteristics and 30-day procedure-related revisits included age 20-29 (odds ratio [OR]: 3.13; 95% confidence intervals [CI]: 2.33-4.20) and age 30-39 (OR: 2.35; CI: 1.91-2.89) compared with age 70-79, male sex (OR: 1.29; CI: 1.24-1.34), races black (OR: 1.37; CI: 1.27-1.48) and Hispanic (OR: 1.16; CI: 1.08-1.24) compared with white, and Medicaid insurance (OR: 1.18, CI: 1.07-1.30) compared with Medicare. Diabetes was also associated with increased 30-day procedure-related revisits (OR: 1.093, CI: 1.024-1.168). Cataract surgery is a common and, in aggregate, expensive procedure. Complication-related revisits follow a similar trend as surgical complications in large-scale population data, and may be useful as a preliminary, screening outcome measure. Our results highlight the importance of age as a risk factor for cataract surgery readmissions, and suggest a relationship between black or Hispanic race, Medicaid insurance, and diabetes associated with higher risk for cataract surgery complications.

Characterizing Readmissions After Bariatric Surgery

IntroductionReadmissions are an important quality metric for surgery. Here, we compare characteristics of readmissions across laparoscopic Roux­en-Y gastric bypass (LRYGB), sleeve gastrectomy (LSG), and adjustable gastric band (LAGB). MethodsDemographic, intraoperative, anthropometric, and laboratory data were prospectively obtained for 1775 patients at a single academic institution. All instances of readmissions within 1 year were recorded. Data were analyzed using STATA, release 12. ResultsFor the 1775 patients, 113 (6.37 %) were readmitted. Mean time to readmission was 52.1 days. Of all the readmissions, 64.6 % were within 30 days, 22.1 % from 30 to 90 days, 1.77 % from 90 to 180 days, and 11.5 % from 180 to 365 days. Incidence of 30-day readmissions varied across surgeries (LRYGB: 7.17 %; LAGB: 3.05 %; LSG: 4.25 %, p = 0.04). Time to readmission varied as well, with 90.0 % of LSG and 80.0 % of LABG patients within the first 30 days, versus 60.8 % of LRYGB (p = 0.02). The most common causes of readmissions were gastrointestinal issues related to index procedure (34.5 %) and did not vary across surgeries. In multivariable logistic regression, index hospital length of stay (LOS) was associated with readmission (OR = 1.07, 95 % CI 1.02–1.13, p = 0.01). ConclusionsReadmissions after bariatric surgery are associated with high index hospital LOS, and a measureable proportion of procedure-related readmissions can occur up to 1 year, especially for LRYGB.

Utility of Readmission Rates as a Quality of Care Measure and Predictors of Readmission Within 30 Days After Spinal Surgery: a Single-Center, Multivariate Analysis.

A retrospective review. The aim of this study was to establish clinically relevant readmission rates that permit accurate comparisons, improve risk-stratification, and direct efforts to minimize readmissions. The 30-day hospital readmission rate is a quality of care measure that is now being used to compare hospitals in a publicly available manner. Records from 1187 consecutive spinal surgeries at Northwestern Memorial Hospital in 2010 were retrospectively reviewed and data were collected that described the patient, surgical procedure, hospital course, complications, and readmissions. The primary outcome of interest was readmission to the hospital within 30 days. Potential risk factors were examined for association with the outcome first via bivariate analysis, with significant predictors further examined by a multivariable model. Identified readmissions were independently reviewed by attending spinal neurosurgeons not involved with the cases to determine whether the readmissions were procedure related or procedure unrelated with respect to accepted criteria. The overall readmission rate was 6.1%. Of these readmissions, 37.5% were deemed procedure related upon attending review, leading to a procedure-related readmission rate of 2.3%. Upon multivariate analysis, only 3 variables were found to be significant predictors of readmission: 2 or more patient comorbidities [odds ratio (OR) 3.72, 95% confidence interval (95% CI) 1.62-8.56], an admission to the ICU (OR 2.68, 95% CI 1.45-4.95), and each additional spinal level involved (OR 1.11, 95% CI 1.02-1.21). Our study suggests that predictors for all-cause 30-day readmission following spinal procedures include number of spinal levels performed during the surgery, number of patient comorbidities present at the time of surgery, and whether the admission required an ICU stay. Future work should focus on developing best practices to modify medical risk factors and comorbidities that have the potential to decrease 30-day readmission rates. 3.

Abstract No. 347 - Safety of same day discharge after renal tumor thermal ablation

Purpose Overnight hospital admission of patients after percutaneous renal ablation remains standard practice for many institutions. The aim of this study is to evaluate the safety of same day discharge of patients who undergo percutaneous CT-guided radiofrequency ablation (RFA) and cryoablation of renal tumors. Materials and Methods An IRB approved retrospective analysis was conducted of patients with renal tumors treated with percutaneous CT-guided RFA and cryoablation between January 2004 and June 2012. Ablation method, tumor size, complications and rates of hospital admissions were analyzed. Results A total of 153 procedures were performed on 134 patients including 82 cryoablations and 71 radiofrequency ablations. All patients were planned to be discharged the same day as their procedure following a standard 4 hour observation period. Overall, five of 153 encounters (3.3%) resulted in patients being admitted overnight. All five admissions occurred because of a complication detected during the first 4 hours after the procedure. Hospital admission was required in 4/71 (5.6%) RFA encounters and in 1/82 (1.2%) cryoablation encounters (p=0.28). Admission was required because of pneumothorax (n=2, one each group) and bleeding (n=3, all in the RFA group). There were no procedure related readmissions after same day discharge however 2/71 (2.8%) RFA encounters had perinephric hematomas detected after discharge but the patients did not require admission. There was no significant difference in the mean tumor size between the RFA (3.1cm) and cryoablation (3.3cm) groups (p=0.4). Conclusion Planned same day discharge after renal cryoablation and RFA is safe with no significant difference detected between the two procedures. Complications requiring admission are low and were detected in the immediate post-procedure observation period.