Assessment of healthcare quality metrics: Length-of-stay, 30-day readmission, and 30-day mortality for radical nephrectomy with inferior vena cava thrombectomy

Y. Joseph Hwang, Brian J. Minnillo, Simon P. Kim, Robert Abouassaly

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Length-of-stay (LOS), 30-day readmission, and 30-day mortality are metrics used to assess quality of care and provider reimbursement. Therefore, we investigated patient- and hospital-level characteristics associated with the three healthcare quality metrics for radical nephrectomy with inferior vena cava (IVC) thrombectomy. Methods: Using the National Cancer Data Base, we established a cohort of patients who received radical nephrectomy following the diagnosis of renal cell carcinoma (RCC) stage cT3b between 1998 and 2011. We then assessed the associations between patient- or hospital-level characteristics and LOS using multivariable negative binomial regression. We used multivariable logistic regression to determine the associations between the characteristics and 30-day readmission or 30-day mortality. Results: During the study period, 5768 patients were diagnosed with RCC stage cT3b and underwent radical nephrectomy. LOS ≤2 days and ≥9 days were associated with a higher likelihood of 30-day readmission (respective odds ratio [OR] 1.61 and 1.58) and 30-day mortality (respective OR 11.62 and 11.87). Older patients (60–79 years vs. <50 years) were less likely to experience 30-day readmission (OR 0.46–0.52). Older patients (≥80 years vs. <50 years, OR 3.67) and patients with a high index of comorbidity (Charlson comorbidity score ≥ 2 vs. 0, OR 1.95) were more likely to suffer 30-day mortality. Conclusions: LOS is an important predictor of short-term readmission and mortality following radical nephrectomy with IVC thrombectomy. Older age and a high index of comorbidity also predict short-term mortality after the surgery.

Original languageEnglish (US)
Pages (from-to)114-121
Number of pages8
JournalJournal of the Canadian Urological Association
Volume9
Issue number3-4APRIL
DOIs
StatePublished - Apr 13 2015
Externally publishedYes

Keywords

  • Hospital readmission
  • Length of stay
  • Mortality
  • Nephrectomy
  • Thrombectomy

ASJC Scopus subject areas

  • Oncology
  • Urology

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