Post-Cystectomy Readmission Predictors Identified
Overweight and obesity, diabetes, and postoperative complications increase radical cystectomy patients' risk of being readmitted within 30 days of hospital discharge.
Elevated body mass index (BMI), diabetes, and postoperative complications are among the risk factors for hospital readmission among patients undergoing radical cystectomy (RC), new study findings suggest.
Compared with normal-weight patients (BMI 18.5–24.9 kg/m2), overweight and obese patients (BMI 25–29.9 and 30 kg/m2 or higher) had significant 1.5-fold increased odds of readmission within 30 days of hospital discharge, Ian Berger, BS, and collaborators at the University of Pennsylvania Perelman School of Medicine in Philadelphia reported in the Canadian Urological Association Journal. Diabetes, chronic obstructive pulmonary disease (COPD), steroid use, and continent diversion were associated with significant 1.2-, 1.4-, 1.5-, and 1.4-fold increased odds of readmission, respectively. Postoperative complications were associated with significant 1.5-fold increased odds of readmission. Longer operations also increased readmission risk. In addition, compared with white patients, black patients had significant 1.5-fold increased odds of readmission within 30 days of hospital discharge.
“Based on study results, actionable targets for improvement may exist in the pre-operative and post-discharge phases,” the authors wrote.
Using the National Surgical Quality Improvement Program database, the investigators identified 4457 patients who underwent RC from 2013 to 2015 and had a hospital length of stay no longer than 14 days. Of these, 20.3% were readmitted, 18.8% experienced a post-discharge complication, and 9.2% experienced a postoperative complication, most commonly infection. Postoperative complications were not associated with post-discharge complications, according to the investigators.
Berger and colleagues noted that the readmission rate found in their study is consistent with rates found in previous studies (19.7% to 28.5%). Noting that previous studies used composite comorbidity or frailty scores in risk adjustment, the authors stated that their study is the first to demonstrate the important association of each independent risk factor with readmission in the RC population.
“Given the different medical and social factors surrounding each individual comorbidity, we hypothesized that some might contribute to readmission risk than others,” they wrote. “In so doing, we identified increasing BMI, diabetes, COPD, and steroid use as independent predictors of readmission, providing evidence that optimizing pre-surgical management of these conditions may reduce risk.”
Berger I, Xia L, Wirtalla C, et al. 30-day readmission after radical cystectomy: Identifying targets for improvement using the phases of surgical care. Can Urol Assoc J. 2018; published online ahead of print.