title: Patterns of care for readmission after radical cystectomy in New York State and the effect of care fragmentation.
abstract: OBJECTIVE
  To determine if readmission after radical cystectomy (RC) to the original hospital of the procedure (OrH) vs. readmission to a different hospital (DiffH) has an effect on outcomes.
  
  
  METHODS
  The New York Statewide Planning and Research Cooperative System database was queried for discharges between January 1, 2009 and November 31, 2012 after RC in New York State. Primary outcome was mortality within 30 and 90 days. Secondary outcomes included length of stay for readmission, rate of transfers/subsequent readmissions, hospital charges per readmission, and, if applicable, length of intensive care unit stays. Multivariate linear regression analyses were performed to adjust for confounding factors in predicting mortality.
  
  
  RESULTS
  During the study period, 2,338 patients were discharged from 100 New York State hospitals after RC. Overall rate of readmission was 28.5% and 39.7% within 30 and 90 days, respectively. Of all readmitted patients, 80.4% and 77.1% were first readmitted to OrH within 30 and 90 days, respectively. Patients readmitted to OrH were younger (P<0.0005) and had a lower All Patient Refined Severity of Illness (P = 0.004). Patients readmitted to DiffH had shorter length of stay (P<0.0005) and lower hospital charges per readmission (P<0.0005), but higher rates of transfers/subsequent readmissions (P = 0.007) and intensive care unit stays (P = 0.002) at 90 days. Patients initially readmitted to DiffH also had a higher rate of mortality (30d, 7.8% vs. 2.3%, P = 0.002; 90d, 5.2% vs. 2.5%, P = 0.05), but initial readmission status was not significant for mortality when controlling for other variables of interest.
  
  
  CONCLUSIONS
  Initial readmission to DiffH vs. OrH after RC was associated with higher rates of mortality, likely owing to underlying differences in the populations.
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY. Electronic address: jamie.pak@mssm.edu.
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Pak
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY.
authors.forename: Danny
authors.initials: D
authors.lastname: Lascano
authors.affiliation: Gold Health Strategies, New York, NY.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Kabat
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY.
authors.forename: Julia B
authors.initials: JB
authors.lastname: Finkelstein
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY.
authors.forename: Arindam
authors.initials: A
authors.lastname: RoyChoudhury
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY.
authors.forename: G Joel
authors.initials: GJ
authors.lastname: DeCastro
authors.affiliation: Gold Health Strategies, New York, NY; Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY.
authors.forename: William
authors.initials: W
authors.lastname: Gold
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY.
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
mesh_terms: D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D015653:Cystectomy; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009518:New York; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*
keywords: Cystectomy; Mortality; Patient readmission; Postoperative care; continuity of patient care