title: Critical Analysis of Hospital Readmission and Cost Burden After Robot-Assisted Radical Cystectomy.
abstract: OBJECTIVE
  To examine the occurrence and cost burden of hospital readmission within 90 days of robot-assisted radical cystectomy (RARC). Subjects/Patients (or Materials) and Methods: From 2003 to 2012, 247 patients underwent RARC with extracorporeal urinary reconstruction at a single categorical cancer hospital. Continent diversions were performed in 67% of patients. All readmissions within 90 days were included. Readmissions were defined as early (<30 days) and late (31-90 days) with multiple readmissions captured as separate events. Cost analysis was performed using average direct hospital cost. The Fisher exact test was used to determine differences in proportion of readmissions between patient groups, while logistic regression was used to identify predictors for readmission.
  
  
  RESULTS
  Ninety-eight (40%) patients were readmitted to the hospital at least once within 90 days after RARC, of which 77% occurred within 30 days. Twenty-seven (11%) required two or more readmissions. Readmissions took place at a median of 13 days after initial discharge. The most common reasons for initial readmission were infections (41%) and dehydration (19%). Stratified by urinary reconstruction type, ileal conduit (dehydration), Indiana pouch (urinary-tract infection without sepsis), and Studer neobladder (sepsis and pelvic abscess) differed by readmission reason. In a multivariable analysis, estimated blood loss was a predictor for readmission (p = 0.05). Patients readmitted to the hospital had direct costs that were 1.42× those who did not require readmission. Readmissions for ileus contributed to the highest cost of readmission, although ureteral stricture, pelvic abscess, and sepsis were the most costly per day of hospitalization. Limitations include retrospective analysis as well as variable thresholds for readmission and costs.
  
  
  CONCLUSIONS
  Hospital readmission rates after RARC are high and costs of readmission are significant. Most patients are readmitted within 30 days and infection and dehydration are common causes. Clinicians should be aware of diversion-specific readmission causes.
authors.affiliation: Division of Urologic Oncology, City of Hope National Cancer Center , Duarte, California.
authors.forename: Kristina
authors.initials: K
authors.lastname: Wittig
authors.affiliation: Division of Urologic Oncology, City of Hope National Cancer Center , Duarte, California.
authors.forename: Nora
authors.initials: N
authors.lastname: Ruel
authors.affiliation: Division of Urologic Oncology, City of Hope National Cancer Center , Duarte, California.
authors.forename: John
authors.initials: J
authors.lastname: Barlog
authors.affiliation: Division of Urologic Oncology, City of Hope National Cancer Center , Duarte, California.
authors.forename: Laura
authors.initials: L
authors.lastname: Crocitto
authors.affiliation: Division of Urologic Oncology, City of Hope National Cancer Center , Duarte, California.
authors.forename: Kevin
authors.initials: K
authors.lastname: Chan
authors.affiliation: Division of Urologic Oncology, City of Hope National Cancer Center , Duarte, California.
authors.forename: Clayton
authors.initials: C
authors.lastname: Lau
authors.affiliation: Division of Urologic Oncology, City of Hope National Cancer Center , Duarte, California.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wilson
authors.affiliation: Division of Urologic Oncology, City of Hope National Cancer Center , Duarte, California.
authors.forename: Bertram
authors.initials: B
authors.lastname: Yuh
mesh_terms: D000038:Abscess / Q000191:economics / Q000453:epidemiology; D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy; D003681:Dehydration / Q000191:economics / Q000453:epidemiology; D005260:Female; D017721:Hospital Costs; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D010388:Pelvis; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D018805:Sepsis / Q000191:economics / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion; D014552:Urinary Tract Infections / Q000191:economics / Q000453:epidemiology