title: No Differences in Population-based Readmissions After Open and Robotic-assisted Radical Cystectomy: Implications for Post-discharge Care.
abstract: To inform whether readmission reduction strategies should consider surgical approach, we examined readmission differences between open and robotic-assisted radical cystectomy (RARC) using population-based data.
  
  
  
  We identified patients who underwent cystectomy between January 2010 and September 2013 based on International Classification of Diseases-9th edition codes and administrative claims from a large, national US health insurer (Clinformatics Data Mart Database, OptumInsight, Eden Prairie, MN). We assessed post-discharge health system utilization and tested for differences in readmissions after the 2 surgical approaches.
  
  
  
  We identified 935 patients treated with cystectomy: open = 785 (84%) and RARC = 150 (16%). Patients undergoing RARC were slightly older, male, had more ileal conduit urinary reconstruction, and less need for intensive care. Index length of stay was shorter for RARC than for open surgery (7 days vs 8 days, P < .001). However, we found no differences in 30-day readmission rates (24% open vs 29% RARC, P = .26) or other readmission parameters, including readmission length of stay (5 days open vs 4 days RARC, P = .32), emergency department use (22% open vs 24% RARC, P = .86), reasons for readmission, or timing of first outpatient visits (11.5 days open vs 9 days RARC, P = .41). For both approaches, the majority of patients were readmitted within 2 weeks.
  
  
  
  The surgical approach to cystectomy does not appear to impact readmissions. Strategies to reduce the readmission burden after cystectomy do not need to consider surgical approach but should focus on timing of medical contacts.
authors.affiliation: Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, MI; Dow Division for Urologic Health Service Research, Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: tborza@med.umich.edu.
authors.forename: Tudor
authors.initials: T
authors.lastname: Borza
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.affiliation: Dow Division for Urologic Health Service Research, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Montgomery
authors.affiliation: Dow Division for Urologic Health Service Research, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Alon Z
authors.initials: AZ
authors.lastname: Weizer
authors.affiliation: Dow Division for Urologic Health Service Research, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Morgan
authors.affiliation: Dow Division for Urologic Health Service Research, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Khaled S
authors.initials: KS
authors.lastname: Hafez
authors.affiliation: Dow Division for Urologic Health Service Research, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Cheryl T
authors.initials: CT
authors.lastname: Lee
authors.affiliation: Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Benjamin Y
authors.initials: BY
authors.lastname: Li
authors.affiliation: Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Hye Sung
authors.initials: HS
authors.lastname: Min
authors.affiliation: Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Chang
authors.initials: C
authors.lastname: He
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Gilbert
authors.affiliation: Indiana University Kelley School of Business, Operations, and Decision Technologies, Bloomington, IN.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Helm
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI.
authors.forename: Mariel S
authors.initials: MS
authors.lastname: Lavieri
authors.affiliation: Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, MI; Dow Division for Urologic Health Service Research, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.affiliation: Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, MI; Dow Division for Urologic Health Service Research, Department of Urology, University of Michigan, Ann Arbor, MI; VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome; D014481:United States; D001743:Urinary Bladder / Q000601:surgery; D014547:Urinary Diversion