title: Determining factors for hospital discharge status after radical cystectomy in a large contemporary cohort.
abstract: OBJECTIVE
  We describe hospital discharge status in patients after radical cystectomy for bladder cancer. We determined factors affecting discharge status.
  
  
  METHODS
  The 445 patients underwent radical cystectomy for urothelial carcinoma from January 2004 to December 2007. Patients were grouped by hospital discharge status into 1 of 4 groups, including home under self-care without services, home with home health services, subacute, rehabilitation or skilled nursing facility, or hospice/in-hospital mortality. We compared clinical, perioperative and pathological variables in these groups. We also examined the association of discharge status with the hospital readmission rate and 90-day mortality.
  
  
  RESULTS
  Of the 440 patients 250 (56.8%), 145 (32.9%), 39 (8.9%) and 6 (1.4%) were in the home without services, home with services, facility and mortality groups, respectively. On multivariate analysis older age, lower preoperative albumin, unmarried status and higher Charlson comorbidity index were predictors of discharge home with services while older age, poor preoperative exercise tolerance and longer hospital stay predicted discharge to a facility. Patients in the facility group were more likely to die within 90 days of surgery than those who returned home independently or with services. There was no difference in the likelihood of rehospitalization.
  
  
  CONCLUSIONS
  Sociodemographic factors, preoperative performance status, and comorbidities and perioperative factors contribute to the discharge decision after radical cystectomy. Some subgroups can be predicted to have increased postoperative care needs and may be appropriate targets for disposition planning preoperatively.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37205, USA. Montyjoon@gmail.com
authors.forename: Monty A
authors.initials: MA
authors.lastname: Aghazadeh
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
authors.forename: Shady
authors.initials: S
authors.lastname: Salem
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: Rodney
authors.initials: R
authors.lastname: Davis
authors.forename: Justin
authors.initials: J
authors.lastname: Gregg
authors.forename: C J
authors.initials: CJ
authors.lastname: Stimson
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy; D006801:Humans; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*