title: Causes of hospital readmissions after urologic cancer surgery.
abstract: OBJECTIVE
  The Hospital Readmissions Reduction Program mandates reimbursement reductions to hospitals with higher than expected rates of readmissions. We examine causes and predictors of readmissions following major procedures in urologic oncology.
  
  
  METHODS
  Using the American College of Surgeons National Surgical Quality Improvement Program database, patients undergoing radical prostatectomy (RP), radical (RN) or partial nephrectomy (PN), and radical cystectomy (RC) during the year 2012 were abstracted. Rates of unplanned readmission within 30 days after surgery, as well as causes of readmission, were identified. Multivariable logistic regression models were fitted to examine the association between patient perioperative factors and odds of readmission.
  
  
  RESULTS
  Overall, we observed a 5.5% unplanned 30-day readmission rate. Readmission rates for patients treated with RP, RN, PN, and RC were 4.1%, 5.2%, 4.5%, and 15.9%, respectively. For each procedure, approximately two-third of readmissions occurred within the first 10 days following hospital discharge. Commonest causes of readmission after RP included thromboembolic (13.6%), wound (12.2%), renal/genitourinary (12.2%), and gastrointestinal (11.8%); after RN, wound (12.9%) and gastrointestinal (12.9%); after PN, renal/genitourinary (19.6%), cardiovascular (9.8%), and bleeding/hematoma (9.8%); and after RC, renal/genitourinary (15.5%), wound (14.8%), and sepsis/infection (14.1%). RC was significantly associated with readmission. Patients undergoing open RP or PN were more likely to be readmitted relative to their minimally invasive counterparts (odds ratio = 1.53, 95% CI: 1.12-2.08, P = 0.007 and odds ratio = 2.51, 95% CI: 1.38-4.55, P = 0.003, respectively).
  
  
  CONCLUSIONS
  Readmissions are relatively common following major urologic oncology procedures. Compared with RP, RN, or PN, RC patients experience the highest burden of readmission. Venous thromboembolism is a common modifiable cause of readmission following urologic cancer surgery. Minimally invasive approach is associated with decreased odds of readmission following RP and PN.
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: dr.marianne.schmid@gmail.com.
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: H Abraham
authors.initials: HA
authors.lastname: Chiang
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Logan
authors.initials: L
authors.lastname: Campbell
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Felix K-H
authors.initials: FK
authors.lastname: Chun
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Deepansh
authors.initials: D
authors.lastname: Dalela
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: James
authors.initials: J
authors.lastname: Okwara
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D014571:Urologic Neoplasms / Q000601:surgery*; D054556:Venous Thromboembolism / Q000209:etiology
keywords: Cancer surgery; Causes; Predictors; Readmission; Urology