title: Incidence and risk factors for 30-day readmission in patients undergoing nephrectomy procedures: a contemporary analysis of 5276 cases from the National Surgical Quality Improvement Program database.
abstract: OBJECTIVE
  To explore factors associated with readmission after nephrectomy procedures using a large national database.
  
  
  METHODS
  A national surgical outcomes database, the American College of Surgeon-National Surgical Quality Improvement Program registry, was queried for data on all patients undergoing open partial nephrectomy (OPN), minimally invasive (laparoscopic + robotic) partial nephrectomy (MIPN), and minimally invasive radical nephrectomy (MIRN) in 2011 and 2012. Patients undergoing these procedures were identified using the Current Procedural Terminology codes. The primary outcome was unplanned 30-day hospital readmission. A multivariate logistic regression model was constructed to assess for factors independently associated with the primary outcome.
  
  
  RESULTS
  Overall, 5276 cases were identified and included in the analysis: 1411 OPN (26.7%), 2210 MIPN (41.8%), and 1655 MIRN (31.3%). Overall, the 30-day readmission rate was 5.9% (7.8% for OPN, 4.5% for MIPN, and 6.1% for MIRN). On multivariate analysis, the odds for 30-day readmission for MIPN was approximately 70% that of OPN (P = .012). The odds for 30-day readmission for 2012 was about 80% of that of 2011 (P <.001). History of steroid use and of bleeding disorder and occurrence of postoperative transfusion increase the odds of readmission by approximately 2 (P = .005, P = .038, and P <.001, respectively). A postoperative urinary infection increased the odds of readmission by 5.5 (P <.001).
  
  
  CONCLUSIONS
  Contemporary 30-day readmission rates after nephrectomy procedures are influenced by specific patients' characteristics as well as postoperative adverse events. Moreover, contemporary MIPN seems to carry lower odds of readmission than OPN. It remains to be determined to what extent these findings are influenced by the expanding role of robotic technology.
authors: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Urology Institute, University Hospitals, Cleveland, OH.
authors: Riccardo
authors: R
authors: Autorino
authors: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors: Homayoun
authors: H
authors: Zargar
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors: Sam
authors: S
authors: Butler
authors: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Urology Institute, University Hospitals, Cleveland, OH.
authors: Humberto
authors: H
authors: Laydner
authors: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: kaoukj@ccf.org.
authors: Jihad H
authors: JH
authors: Kaouk
mesh_terms: D000368:Aged; D001778:Blood Coagulation Disorders / Q000453:epidemiology; D001803:Blood Transfusion; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D013256:Steroids / Q000627:therapeutic use; D013530:Surgical Wound Infection / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology*; D020246:Venous Thrombosis / Q000209:etiology
chemical_list: D013256:Steroids