title: Risk factors for infectious readmissions following radical cystectomy: results from a prospective multicenter dataset.
abstract: BACKGROUND
  Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder cancer. This procedure has a high rate of perioperative complications, many of which are infectious in nature. The objective of our study was to evaluate demographic, intrinsic and extrinsic patient variables associated with developing readmission within 30 days due to infectious complications following RC.
  
  
  METHODS
  We acquired data available from the American College of Surgeons National Surgical Quality Improvement Program. We queried this dataset to identify all patients who underwent RC for muscle-invasive malignant disease (CPT 188.x) in 2012 based on CPT coding. Logistic regression analysis was used to investigate the relationship between preoperative variables and readmissions for infectious complications.
  
  
  RESULTS
  Of the 961 patients undergoing cystectomy for malignancy, 159 (17%) required readmission for any indications at a median of 16 days (interquartile range 13-22 days) postoperatively. We identified 71 of a total of 159 (45%) readmissions, which were due to infectious complications. Smoking was more prevalent in the patient population readmitted for an infectious complication compared with the patient population readmitted for a non-infectious complication (37% versus 25%; p = 0.03). Using logistic regression analysis smoking was associated with a significant risk for readmission due to an infectious cause (odds ratio 2.28, 95% confidence interval 1.82-2.97, p = 0.02). Readmission due to an infectious etiology was not associated with other perioperative factors including type of urinary diversion, sex, duration of operation, hypertension, or recent weight loss.
  
  
  CONCLUSIONS
  Readmission following RC is a common occurrence and infectious complications drive readmission in almost half of the cases. Current smoking was the only independent risk factor for an infectious readmission. Counseling patients in smoking cessation prior to the procedure may provide an avenue for quality improvement to limit readmissions.
authors.affiliation: Wake Forest School of Medicine, Department of Urology, Medical Center Boulevard, Winston Salem, NC 27106, USA.
authors.forename: Sij
authors.initials: S
authors.lastname: Hemal
authors.affiliation: Department of Urology, Wake Forest Baptist Health, Winston Salem, NC, USA.
authors.forename: Louis S
authors.initials: LS
authors.lastname: Krane
authors.affiliation: Department of Urology, University of Wisconsin School of Medicine, Madison, WI, USA.
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Richards
authors.affiliation: Department of Urology, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Liss
authors.affiliation: Department of Urology, University of California at San Diego, La Jolla, CA, USA.
authors.forename: A Karim
authors.initials: AK
authors.lastname: Kader
authors.affiliation: Department of Urology, Wake Forest Baptist Health, Winston Salem, NC, USA.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Davis
keywords: National Surgical Quality Improvement Program; bladder cancer; complications; cystectomy; smoking