Readmissions after radical cystectomy are common and time-dependent. Interventions to prevent and reduce the readmission burden after cystectomy likely need to focus on the first 2 weeks after discharge, take into consideration the spectrum of reasons for readmission, and target high-risk individuals.
Sharpening the focus on causes and timing of readmission after radical cystectomy for bladder cancer
Article first published online: 29 JAN 2014
© 2014 American Cancer Society
Volume 120, Issue 9, pages 1409–1416, 1 May 2014
How to Cite
Hu, M., Jacobs, B. L., Montgomery, J. S., He, C., Ye, J., Zhang, Y., Brathwaite, J., Morgan, T. M., Hafez, K. S., Weizer, A. Z., Gilbert, S. M., Lee, C. T., Lavieri, M. S., Helm, J. E., Hollenbeck, B. K. and Skolarus, T. A. (2014), Sharpening the focus on causes and timing of readmission after radical cystectomy for bladder cancer. Cancer, 120: 1409–1416. doi: 10.1002/cncr.28586
- Issue published online: 22 APR 2014
- Article first published online: 29 JAN 2014
- Manuscript Accepted: 2 DEC 2013
- Manuscript Revised: 25 NOV 2013
- Manuscript Received: 15 OCT 2013
- bladder cancer;
- operations engineering
Readmissions after radical cystectomy are common, burdensome, and poorly understood. For these reasons, the authors conducted a population-based study that focused on the causes of and time to readmission after radical cystectomy.
Using Surveillance, Epidemiology, and End Results-Medicare data, at total of 1782 patients who underwent radical cystectomy from 2003 through 2009 were identified. A piecewise exponential model was used to examine reasons for readmission as well as patient and clinical factors associated with the timing of readmission.
One in 4 patients (25.5%) were readmitted within 30 days of discharge after radical cystectomy. Compared with patients without readmission, those readmitted were similar with regard to age, sex, and race. Readmitted patients had more complications (33.8% vs 13.9%; P < .001) and were more likely to have been discharged to skilled nursing facilities from their index admission (P < .001). The average time to readmission and subsequent length of stay were 11.5 days and 6.7 days, respectively. The majority of readmissions (67.4%) occurred within 2 weeks of discharge, 66.8% had emergency department charges, and 25.9% involved intensive care unit use. Although the spectrum of reasons for readmission varied over the 4 weeks after discharge, the most common included infection (51.4%), failure to thrive (36.3%), and urinary (33.2%) and gastrointestinal (23.1%) etiologies; 95.8% of patients had ≥ 1 of these diagnosis groups present at the time of readmission.
Readmissions after radical cystectomy are common and time-dependent. Interventions to prevent and reduce the readmission burden after cystectomy likely need to focus on the first 2 weeks after discharge, take into consideration the spectrum of reasons for readmission, and target high-risk individuals. Cancer 2014;120:1409–1416. © 2014 American Cancer Society.