title: 30-day hospital readmission after robotic partial nephrectomy--are we prepared for Medicare readmission reduction program?
abstract: OBJECTIVE
  After CMS introduced the concept of the Hospital Readmissions Reduction Program, hospitals and health care centers became financially penalized for exceeding specific readmission rates.
  
  
  METHODS
  We retrospectively reviewed our institutional review board approved database of patients undergoing robotic partial nephrectomy at our institution and included in our analysis patients who were readmitted to any hospital as an inpatient stay within 30 days from discharge home after robotic partial nephrectomy.
  
  
  RESULTS
  From March 2006 to March 2013 a total of 627 patients underwent robotic partial nephrectomy at our center and 28 (4.46%) were readmitted within 30 days of surgery. Postoperative bleeding was responsible for 8 (28.5%) readmissions. Pulmonary embolism was reported in 3 cases and retroperitoneal abscess was diagnosed in 2. Urinary leak requiring surgical intervention developed in 2 patients, pneumonia was diagnosed in 2 and 2 patients were readmitted for chest pain. Overall 9 (32.1%) patients presented with major complications requiring intervention. On multivariable analysis Charlson comorbidity index score was the only factor significantly associated with a higher 30-day readmission rate (p = 0.03). If the Charlson score was 5 or greater the chance of hospital readmission would be 2.7 times higher.
  
  
  CONCLUSIONS
  Increased comorbidity, specifically a Charlson score of 5 or greater, was the only significant predictor of a higher incidence of 30-day readmission. This information can be useful in counseling patients regarding robotic partial nephrectomy and in determining baseline rates if CMS expands the number of conditions they evaluate for excess 30-day readmissions.
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Luis Felipe
authors: LF
authors: Brandao
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Homayoun
authors: H
authors: Zargar
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Humberto
authors: H
authors: Laydner
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Oktay
authors: O
authors: Akca
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Riccardo
authors: R
authors: Autorino
authors: Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors: Oliver
authors: O
authors: Ko
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Dinesh
authors: D
authors: Samarasekera
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors: Jianbo
authors: J
authors: Li
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors: John
authors: J
authors: Rabets
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Jayram
authors: J
authors: Krishnan
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Georges-Pascal
authors: GP
authors: Haber
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Jihad
authors: J
authors: Kaouk
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: steinr@ccf.org.
authors: Robert J
authors: RJ
authors: Stein
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012371:Robotics; D013997:Time Factors; D014481:United States
keywords: laparoscopy; minimally invasive; nephrectomy; patient readmission; postoperative complications; surgical procedures