title: Understanding hospital readmission intensity after radical cystectomy.
abstract: OBJECTIVE
  Hospital readmissions after radical cystectomy vary with respect to intensity in terms of impact on patients and health care systems. Therefore, we conducted a population based study to examine factors associated with increasing readmission intensity after radical cystectomy for bladder cancer.
  
  
  METHODS
  Using SEER (Surveillance, Epidemiology, and End Results)-Medicare data we identified 1,782 patients who underwent radical cystectomy from 2003 to 2009. We defined readmission intensity in terms of length of stay (days) divided into quartiles of less than 3 (lowest), 3 to 4, 5 to 7 and more than 7 (highest). We used logistic regression to examine factors associated with readmission intensity.
  
  
  RESULTS
  More than half of the patients with the highest intensity readmissions were readmitted within the first week and 77% were readmitted within 2 weeks of discharge. Patients with the highest intensity readmissions were similar in age, gender, race, socioeconomic status, pathological stage, comorbidity, neoadjuvant chemotherapy use and urinary diversion type compared to patients with the lowest intensity readmissions. After multivariable adjustment, complications during the index cystectomy admission (p <0.001), readmission week (p=0.04), and the interaction between index length of stay and discharge to a skilled nursing facility (p=0.04) were associated with the highest readmission intensity.
  
  
  CONCLUSIONS
  Readmission intensity differs widely after discharge following radical cystectomy. As postoperative efforts to minimize the readmission burden increase, a better understanding of the factors that contribute to the highest intensity readmissions will help direct limited resources (eg telephone calls, office visits) toward high yield areas.
authors.affiliation: VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, Michigan; Division of Oncology, University of Michigan, Ann Arbor, Michigan; Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan. Electronic address: tskolar@med.umich.edu.
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.affiliation: Division of Oncology, University of Michigan, Ann Arbor, Michigan; Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan.
authors.forename: Florian R
authors.initials: FR
authors.lastname: Schroeck
authors.affiliation: Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan.
authors.forename: Chang
authors.initials: C
authors.lastname: He
authors.affiliation: Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Helfand
authors.affiliation: Indiana University Kelley School of Business, Indianapolis, Indiana.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Helm
authors.affiliation: Department of Urology, and Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Hu
authors.affiliation: Department of Urology, and Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan.
authors.forename: Mariel
authors.initials: M
authors.lastname: Lavieri
authors.affiliation: Division of Oncology, University of Michigan, Ann Arbor, Michigan; Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: cystectomy; health care; patient readmission; quality assurance; urinary bladder neoplasms