Readmission Risk Factors for Radical Nephrectomy Patients Identified
Race, procedure and insurance type, sex, surgeon volume, and hospital size influence the risk of readmission among patients undergoing radical nephrectomy, study finds.
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SAN FRANCISCO—Multiple patient and provider factors can predict readmission within 90 days for patients who undergo radical nephrectomy (RN), Anthony Yang, MD, of the Icahn School of Medicine at Mount Sinai in New York, and colleagues reported in a poster presentation at the American Urological Association 2018 annual meeting.
Of 47,153 patients who underwent RN during 1995 to 2015, 14.9% were readmitted within 90 days of surgery, according to a New York State database. Postoperative infection (4.6%) and acute renal failure (3.2%) topped the list of diagnoses. On multivariate analysis, risk factors for readmission included female sex, Hispanic ethnicity, black race, low income, multiple comorbidities, Medicaid or Medicare coverage, and large hospital size (more than 600 beds).
The odds of readmission were 9% higher among female vs male patients, 28% higher among blacks vs whites, 20% higher among Hispanics vs non-Hispanic, 14% higher among patients in the bottom vs top quartile of income, 25% higher among Medicaid recipients vs privately insured patients, and 19% higher among patients treated at hospitals with more than 600 vs fewer than 200 beds.
Certain factors were associated with lower likelihood of readmission: age older than 45, higher surgeon volume, and laparoscopic or robotic surgery. The odds of readmission were 20% lower among patients aged 45–65 years vs those younger than 45 years and 27% lower among patients treated by surgeons in the top vs bottom quartile of surgical volume. In addition, laparoscopic vs open procedures were associated with 12% decreased odds of readmission and robotic vs open procedures were associated with 21% decreased odds.
“Utilization of these patient and provider characteristics may guide identification of high-risk patients, perioperative treatment optimization, and patient counseling,” Dr Yang told Renal & Urology News. “Certain patient characteristics such as female gender, Hispanic ethnicity, black race, low income, and co-morbidities may help physicians identify high-risk patients undergoing radical nephrectomy who may be subjected to postoperative complications resulting in readmission.
“Our study also underscores the impact of the surgeon in determining outcome and the need for increased recognition, research, and possible regulation to ensure the provision of high quality patient care.” The study findings agree with prior studies on various diseases and procedures showing increased surgeon volume leads to better outcomes, Dr Yang added. For this reason, institutions are increasingly adopting a ‘Center of Excellence' model. The team is planning a future study examining the quantitative effects of increased surgeon volume on outcomes, among other projects on the topic.
Yang A, Finkelstein M, Bilal K, et al. Predictors of readmissions within 90 days following radical nephrectomy: a population-based analysis from 1995 to 2015. Data presented in poster format at the American Urological Association 2018 annual meeting, May 18–21. Abstract MP36-18.