title: Patient-centered risk stratification of disposition outcomes following radical cystectomy.
abstract: OBJECTIVE
  Patient-centered care involves providing understandable information to facilitate individualized health decisions among patients. We sought to determine the effect of age and comorbidity status on clinically meaningful outcomes following radical cystectomy (RC), in an effort the help optimize patient selection and enhance discussions among those considering surgery.
  
  
  METHODS
  In a retrospective review, 6,460 patients were treated with RC for bladder cancer from the U.S. Premier Perspectives Database between 2007 and 2013. The influence of age and comorbidity count on the rates of inpatient mortality, prolonged length of stay (LOS), disposition to other than home and hospital readmission within the month of surgery or month after, were assessed. Comorbidity was calculated using the Elixhauser method. Prolonged LOS was defined as >10 days. Multivariable logistic regression models were used.
  
  
  RESULTS
  Following RC, 16% of patients were discharged to somewhere other than home, 37% had a prolonged LOS and 2% died during the index admission. Among those discharged home after surgery, 27% of patients were readmitted. Prolonged LOS was associated with increasing comorbidities and age >70 years (P < 0.001). The adjusted likelihood of readmission increased with increasing burden of comorbid conditions (P < 0.001), however, not with age. The likelihood of being discharged to other than home increased with age and comorbidity count (P < 0.001). Mortality was associated with ≥3 comorbidities and age >70 years.
  
  
  CONCLUSIONS
  Increasing age and comorbidity are associated with poorer outcomes following RC, with comorbidity being the predominant factor. Our findings may improve surgical selection and better align patient expectations following surgery by providing estimated rates of postoperative events for patients considering RC.
authors.affiliation: Department of Urology, University of Washington, Seattle, WA, USA. Electronic address: jnayak@uw.edu.
authors.forename: Jasmir G
authors.initials: JG
authors.lastname: Nayak
authors.affiliation: Department of Urology, University of Washington, Seattle, WA, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
authors.affiliation: Department of Urology, University of Washington, Seattle, WA, USA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Holt
authors.affiliation: Department of Urology, University of Washington, Seattle, WA, USA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Wright
authors.affiliation: Department of Urology, University of Washington, Seattle, WA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Mossanen
authors.affiliation: Department of Urology, University of Washington, Seattle, WA, USA.
authors.forename: Atreya
authors.initials: A
authors.lastname: Dash
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D015653:Cystectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000379:methods* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
keywords: Disposition; Morbidity; Mortality; Patient-centered; Radical cystectomy