30-day readmission after radical cystectomy: Identifying targets for improvement using the phases of surgical care
dc.contributor.author | Berger, Ian | |
dc.contributor.author | Xia, Leilei | |
dc.contributor.author | Wirtalla, Christopher | |
dc.contributor.author | Dowzicky, Phillip | |
dc.contributor.author | Guzzo, Thomas J | |
dc.contributor.author | Kelz, Rachel R | |
dc.date.accessioned | 2019-10-24T18:24:31Z | |
dc.date.available | 2019-10-24T18:24:31Z | |
dc.date.updated | 2019-10-24T18:24:31Z | |
dc.description.abstract | <jats:p>Introduction: Postoperative readmissions following radical cystectomy (RC) have gained attention in the past decade. Postoperative and post-discharge complications play a role in readmission rates; however, our ability to predict readmissions remains poor.Methods: Using the National Surgical Quality Improvement Program database, we identified patients with bladder cancer undergoing RC from 2013–2015. Complications were defined as postoperative and post-discharge. Outcomes were 30-day readmission, post-discharge complications, and post-discharge major complications. Patient, operative, and complication factors were assessed using multivariable logistic regression.Results: We identified 4457 patients who underwent RC; 9.2% of patients experienced a postoperative complication, 18.8% experienced a post-discharge complication, and 20.3% were readmitted. Overweight and obese body mass index (BMI), dependent functional status, chronic obstructive pulmonary disease (COPD), a continent diversion, and duration of operation were associated with post-discharge complications. Postoperative complications were not associated with post-discharge complications. Readmission was associated with Black race (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.0–2.1), overweight (OR 1.5; 95% CI 1.2–1.8) and obese BMI (OR 1.5; 95% CI 1.2–1.9), diabetes (OR 1.2; 95% CI 1.0–1.5), COPD (OR 1.4; 95% CI 1.0–1.8), steroid use (OR 1.5; 95% CI 1.0–2.2), a continent diversion (OR 1.4; 95% CI 1.1–1.7), duration of operation (OR 1.1; 95% CI 1.1–1.2), and postoperative complications (OR 1.5; 95% CI 1.2–2.0). The majority of readmissions experienced a post-discharge complication.Conclusions: Factors that span the preoperative, intraoperative, postoperative, and post-discharge phases of care were identified to increase readmission risk. To improve readmission rates, interventions will have to target factors across the surgical experience.</jats:p> | |
dc.identifier.issn | 1911-6470 | |
dc.identifier.issn | 1920-1214 | |
dc.identifier.uri | ||
dc.publisher | Canadian Urological Association Journal | |
dc.relation.ispartof | Canadian Urological Association Journal | |
dc.relation.isversionof | 10.5489/cuaj.5455 | |
dc.title | 30-day readmission after radical cystectomy: Identifying targets for improvement using the phases of surgical care | |
dc.type | Journal article | |
duke.contributor.orcid | Berger, Ian|0000-0002-6271-0548 | |
pubs.issue | 7 | |
pubs.organisational-group | Staff | |
pubs.organisational-group | Duke | |
pubs.organisational-group | Surgery | |
pubs.organisational-group | Clinical Science Departments | |
pubs.organisational-group | School of Medicine | |
pubs.publication-status | Published online | |
pubs.volume | 13 |
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