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UPJ INSIGHT: Patient, Physician, Hospital Factors Associated With Readmission After Radical Cystectomy
By: Kassem S. Faraj, MD; Lanyu Mi, MS; Mark D. Tyson, MD, MPH | Posted on: 01 Dec 2022
Faraj KS, Mi L, Tyson MD. Patient, physician, hospital factors associated with readmission after radical cystectomy. Urol Pract. 2022;9(6):589-595.
Study Need and Importance
Patient and clinical factors are the most commonly identified variables associated with hospital readmission after radical cystectomy, but other factors may be important drivers of outcomes, such as hospital and physician characteristics. This study investigates the contribution of patient, physician, and hospital factors on hospital readmission after radical cystectomy.
What We Found
Of 3,530 patients analyzed within the Surveillance Epidemiology, and End Results-Medicare database, 1,291 (36.6%) were readmitted within 90 days of the index surgery. Complications were more frequent in the readmission cohort (89.0% vs 55.2%, P < .001). On multilevel multivariable analysis, factors significantly associated with readmission included continent urinary diversion (OR 1.55, 95% CI 1.21, 2.00), greater National Cancer Institute comorbidity index (2-<4 vs 0-<2, OR 1.35, 95% CI 1.05, 1.75; 4+ vs 0-<2, OR 1.76, 95% CI 1.20, 2.58), American Joint Committee on Cancer stage (P = .04), and hospital region (P = .05). Neither hospital volume, physician volume, teaching hospital status, nor National Cancer Institute center designation was associated with hospital readmission. The main source of variation was determined to be the patient factors (95.89%), followed by the physician (1.43%), and then hospital (2.68%) factors.
Limitations
The major limitations of this study include its retrospective nature, use of a national database, and inability to account for surgeries outside of the Medicare database. Though surgeon and hospital volumes were categorized by percentile, it is possible that not accounting for surgeries outside of the Medicare database may have resulted in underestimation of respective volumes. Additionally, because the study uses claims from Medicare patients, it may not be fully generalizable to the general population.
Interpretation for Patient Care
Patient-specific factors are the most important in impacting the odds of readmission. Postoperative complications are the main drivers of hospital readmission. Efforts to reduce readmissions at the patient level could include optimizing comorbidities and performance status prior to surgery and closer follow-up for patients with continent diversions after discharge.
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