Few modifiable factors predict readmission following radical cystectomy.
BACKGROUND
We sought to determine the patient and provider-related factors associated with readmission after radical cystectomy (RC) for bladder cancer. In this era of healthcare reform, hospital performance measures, such as readmission, are beginning to affect provider reimbursement. Given its high readmission rate, RC could be a target for quality improvement.


METHODS
We reviewed bladder cancer patients who underwent RC in California's State Inpatient Database (2005-2009) of the Healthcare Cost and Utilization Project. We examined patient-(e.g., race, discharge disposition) and provider-related factors (e.g., volume) and evaluated their association with 30-day readmission. Multivariable logistic regression was used to examine associations of interest.


RESULTS
Overall, 22.8% (n = 833) of the 3649 patients who underwent RC were readmitted within 30 days. Regarding disposition, 34.8%, 50.8%, and 12.2% were discharged home, home with home healthcare, and to a post-acute care facility (PACF), respectively. Within 30 days, 20.3%, 20.9%, and 42.3% were discharged home, home with home healthcare, and to a PACF were readmitted, respectively. African Americans (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.07-2.50), having ≥2 comorbidities (OR 1.42, 95% CI 1.06-1.91), receiving a neobladder (OR 1.45, 95% CI 1.09-1.93), and discharged to a PACF (OR 3.79, 95% CI 2.88-4.98) were independent factors associated with readmission. Hospital stays ≥15 days were associated with less readmission (OR 0.43, 95% CI 0.27-0.67, p = 0.0002). Procedure volume was not associated with complication, in-hospital mortality, or readmission.


CONCLUSIONS
About one-fifth of patients undergoing RC are readmitted. Patients who are discharged to a PACF, African American, and who have more extensive comorbidities tend to experience more readmissions. Increased efforts with care coordination among these patients may help reduce readmissions.
Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;
Brian J
BJ
Minnillo
Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;
Matthew J
MJ
Maurice
Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH; ; Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH.
Nicholas
N
Schiltz
Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH; ; Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH.
Aiswarya C
AC
Pillai
Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH; ; Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH.
Siran M
SM
Koroukian
Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;
Firouz
F
Daneshgari
Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; ; Yale University, COPPER Center, New Haven, CT;
Sim P
SP
Kim
Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;
Robert
R
Abouassaly