title: Readmissions after major urologic cancer surgery.
abstract: BACKGROUND
  We examine the incidence and predictors of readmission after major urologic cancer surgery using a national, prospective-maintained database specifically developed to assess quality of surgical care.
  
  
  METHODS
  Patients undergoing major urologic cancer surgery (radical prostatectomy [RP], radical nephrectomy [RNx], partial nephrectomy [PNx]), radical cystectomy [RC]) in 2011 were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) using Current Procedural Terminology (CPT) codes. Those readmitted within 30 days after surgery were identified. Multivariable logistic regression models examined the association between patient characteristics and the odds of readmission.
  
  
  RESULTS
  Overall, we identified 5356 RP, 1301 RNx, 918 PNx and 623 RC patients, of which 206 (3.8%), 533 (6.8%), 348 (6.3%) and 129 (20.7%) were readmitted within 30 days respectively. Independent predictors of readmission for RP included age (Odds Ratio [OR]: 1.02, p = 0.02), American Society of Anesthesiology (ASA) score 3-5 (versus 1-2, OR: 1.35, p = 0.04), smoking status (OR: 1.53, p = 0.04), and the occurrence of wound complications (OR: 9.31, p < 0.001), thromboembolic (OR: 14.7, p < 0.001), and renal failure (OR: 1.62, p = 0.01) complications during the index hospitalization. For RC patients, the only predictor of readmission was age (OR: 0.98, p = 0.04). Predictors of readmission for RNx included higher ASA score (OR: 1.77, p = 0.03), and the presence of any complications during the index hospitalization (OR: 2.21, p = 0.03).
  
  
  CONCLUSIONS
  Several patient characteristics have a significant impact on the risk of 30 day readmission after major urologic cancer surgery. Our data suggests that improving prevention and management of complications during the index hospitalization may lead to a substantial decrease in readmission rates.
authors.affiliation: Center for Surgery and Public Health and Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Leow
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.forename: Nedim
authors.initials: N
authors.lastname: Ruhotina
authors.forename: Dane E
authors.initials: DE
authors.lastname: Klett
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000367:Age Factors; D000368:Aged; D015653:Cystectomy / Q000706:statistics & numerical data*; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011468:Prostatectomy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014571:Urologic Neoplasms / Q000453:epidemiology / Q000601:surgery*