I. Berger1, C. Wirtalla1, J. Ziemba2, T. Guzzo2, R. Kelz1 1University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA 2University Of Pennsylvania,Department Of Urology,Philadelphia, PA, USA
Introduction: Efforts have been made to reduce post-operative readmissions due to their large burden on patients and the healthcare system. In spite of this, radical cystectomy remains a particularly morbid operation and with high rates of readmission. While patient demographics for radical cystectomy have failed to preoperatively identify high risk patients for readmission, postoperative occurrences are known to be a risk factor for readmission. However, their timing has not been appropriately described in radical cystectomy. In this study we sought to characterize postoperative occurrences with respect to their timing and association with readmission in order to target quality improvement interventions.
Methods: The National Surgical Quality Improvement Program database was queried for patients undergoing radical cystectomy from 2013-2015 using Common Procedural Terminology codes. Postoperative occurrences were identified and their impact on readmissions within 30 days of surgery was evaluated through multivariable analysis. Postoperative occurrences were characterized as predischarge or postdischarge, and their timing was described.
Results: 4,585 patients were identified with a mean length of stay of 8 days. Readmission rate was 24% and postoperative occurrence rate was 26%. There was a 62% rate of readmission in patients with any postoperative occurrence compared to 11% in patients that did not experience an occurrence (p<0.001). The greatest risk factor for readmission was the presence of a postdischarge occurrence (relative risk, 4.06 [95% CI, 3.97-4.15]). Readmission rates for patients with a predischarge versus a postdischarge occurrences were 28% and 79% (p<0.001). The median time of any postdischarge occurrence was 9 days. Urinary tract infection, sepsis, wound complication, and organ space infection were the most common postoperative occurrences with median times to occurrence of 10, 10, 8, and 10 days following discharge respectively. Frequency for each occurrence is shown in Figure 1.
Conclusion: Patients who experience a postoperative occurrence following radical cystectomy have a significantly higher risk of being readmitted. This risk is elevated even more if the event occurs after discharge. Infections are the most common form of postoperative occurrence and our study indicates that the majority occur before two weeks, a common time for a postoperative outpatient appointment. Outpatient interventions that target the first two weeks following discharge may be effective at identifying occurrences early and lowering readmission rates.
