title: Readmissions in the postoperative period following urinary diversion.
abstract: OBJECTIVE
  Most analyses of complications after urinary diversion are restricted to the index admission. Given the complexity of these reconstructions, readmissions occur commonly. We sought to characterize the burden and impact of readmissions in the postoperative period following urinary diversion.
  
  
  METHODS
  Using 5% Medicare data for the years 1998-2005, we identified patients undergoing ileal conduit, continent, and other urinary diversions for benign and malignant indications. We examined the 90-day rates of readmission and evaluated factors associated with readmission after urinary diversion, either to the primary hospital or to a secondary facility. We assessed 90-day and 2-year mortality after urinary diversion and incorporated readmission status as a covariate in these multivariable models.
  
  
  RESULTS
  Our study sample included 1,565 patients, of whom 491 patients (31%) were readmitted within 90 days of their urinary diversion. Patients readmitted after urinary diversion had higher comorbidity count than those not readmitted (59% of those readmitted with comorbidity count at least 1 versus 50% of those not readmitted, P=0.002). Other clinical and demographic characteristics did not differ by readmission status (P>0.12 for age, race, type of urinary diversion, and primary diagnosis). Complication rates were higher in readmitted patients than those not readmitted; 2-year mortality was associated with 90-day readmission status-18.8% of readmitted versus 12.8% of not readmitted patients died within 2 years of surgery (P=0.003).
  
  
  CONCLUSIONS
  Readmissions occur commonly after urinary diversion. Many readmitted patients have complications of complex surgery managed at secondary hospitals, which may portend a quality concern that merits further study.
authors.affiliation: Department of Urology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356510, Seattle, WA 98195-6510, USA. jlgore@u.washington.edu
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
authors.forename: Julie
authors.initials: J
authors.lastname: Lai
authors.forename: Scott M
authors.initials: SM
authors.lastname: Gilbert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States; D001743:Urinary Bladder / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects*