Readmission after robot-assisted radical cystectomy: outcomes and predictors at 90-day follow-up.
OBJECTIVE
To characterize the outcomes and predictors of readmission after robot-assisted radical cystectomy (RARC) during early (30-day) and late (31-90-day) postoperative periods.


METHODS
We retrospectively evaluated our prospectively maintained RARC quality assurance database of 272 consecutive patients operated between 2005 and 2012. We evaluated the relationship of readmission with perioperative outcomes and examined possible predictors during the postoperative period.


RESULTS
Overall 30- and 90-day mortality was 0.7% and 4.8%, respectively, with 25.5% patients readmitted within 90 days after RARC (61% of them were readmitted within 30 days and 39% were readmitted between 31-90 days postoperatively). Infection-related problems were the most common cause of readmission during early and late periods. Overall operative time and obesity were significantly associated with readmission (P = .034 and .033, respectively). Body mass index and female gender were independent predictors of 90-day readmission (P = .004 and .014, respectively). Having any type of complication correlated with 90-day readmission (P = .0045); meanwhile, when complications were graded on the basis of Clavien grading system, only grade 1-2 complications statistically correlated with readmission (P = .046). Four patients needed reoperation (2 patients in early "for appendicitis and adhesive small bowel obstruction" and 2 in late "for ureteroenteric stricture" readmission); meanwhile, 6 patients needed percutaneous procedures (4 patients in early "1 for anastomotic leak and 3 for pelvic collections" and 2 "for pelvic collections and ureterocutaneous fistula" in late readmission).


CONCLUSIONS
The rate of readmission within 90 days after RARC is significant. Female gender and body mass index are independent predictors of readmission. Outcomes at 90 days provide more thorough results, essential to proper patient counseling.
Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
Ali
A
Al-Daghmin
Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
Ahmed
A
Aboumohamed
Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
Rakeeba
R
Din
Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
Aabroo
A
Khan
Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
Syed Johar
SJ
Raza
Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
Jenna
J
Sztorc
Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
Diana
D
Mehedint
Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
Mohammad
M
Sharif
Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY.
Yi
Y
Shi
Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY.
Gregory
G
Wilding
Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. Electronic address: Khurshid.Guru@RoswellPark.org.
Khurshid A
KA
Guru
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D012371:Robotics; D013997:Time Factors