Sharpening the focus on causes and timing of readmission after radical cystectomy for bladder cancer.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan.
Michael
M
Hu
Bruce L
BL
Jacobs
Jeffrey S
JS
Montgomery
Chang
C
He
Jun
J
Ye
Yun
Y
Zhang
Julien
J
Brathwaite
Todd M
TM
Morgan
Khaled S
KS
Hafez
Alon Z
AZ
Weizer
Scott M
SM
Gilbert
Cheryl T
CT
Lee
Mariel S
MS
Lavieri
Jonathan E
JE
Helm
Brent K
BK
Hollenbeck
Ted A
TA
Skolarus
D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
bladder cancer; cystectomy; operations engineering; quality; readmission