Causes, Timing, Hospital Costs and Perioperative Outcomes of Index vs Nonindex Hospital Readmissions after Radical Cystectomy: Implications for Regionalization of Care

Research output: Contribution to journalArticle

Abstract

Purpose We compared the timing, causes, hospital costs and perioperative outcomes of index vs nonindex hospital readmissions after radical cystectomy. Materials and Methods The 2013 Nationwide Readmissions Database was queried for patients with bladder cancer undergoing cystectomy. Sociodemographic characteristics, hospital costs and causes of readmission were compared among index and nonindex readmitted patients. Univariable and multivariable logistic regression models were used to identify predictors of nonindex readmissions, mortality during the first readmission and subsequent readmission. Results Among 4,991 patients identified 29% (1,447) and 11% (571) experienced an index and nonindex readmission, respectively. Compared to index readmissions, nonindex readmissions were more likely late readmissions (p <0.001) of older patients (p=0.047) who underwent cystectomy at higher volume hospitals (p=0.02) and were readmitted to hospitals located in less populated areas (p <0.001). Compared to index readmissions the percentage of nonindex readmissions for cardiovascular complications was higher (7.6% vs 2.9%, p=0.003), while the percentage of nonindex readmissions for gastrointestinal (6.0% vs 11.0%, p=0.04) and wound (5.3% vs 16.7%, p=0.0001) complications was lower. Predictors of nonindex readmission included longer length of stay (OR 1.02; 95% CI 1.001, 1.04), patient location in less populated areas, nonteaching hospital (OR 0.52; 95% CI 0.31, 0.86) and discharge to facility (OR 2.82; 95% CI 1.75, 4.55) or with home health (OR 1.49; 95% CI 1.05, 2.10). Nonindex readmissions had comparable mean readmission hospital costs ($14,147 vs $15,102, p=0.7), in-hospital mortality (OR 1.11; 95% CI 0.42, 2.87) and subsequent readmission (OR 1.32; 95% CI 0.87, 2.00) to index readmissions. Conclusions This nationally representative study of patients undergoing radical cystectomy demonstrated comparable perioperative outcomes and hospital costs between index and nonindex readmitted patients, which supports the continued regionalization of cystectomy care.

Original languageEnglish (US)
Pages (from-to)296-301
Number of pages6
JournalJournal of Urology
Volume197
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Patient Readmission
Hospital Costs
Cystectomy
Logistic Models
High-Volume Hospitals
Patient Advocacy
Hospital Mortality
Urinary Bladder Neoplasms
Length of Stay
Databases
Mortality
Health
Wounds and Injuries

Keywords

  • continuity of patient care
  • cystectomy
  • patient readmission
  • postoperative care
  • urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

@article{4267b098b45c459c8047192501f2be5f,
title = "Causes, Timing, Hospital Costs and Perioperative Outcomes of Index vs Nonindex Hospital Readmissions after Radical Cystectomy: Implications for Regionalization of Care",
abstract = "Purpose We compared the timing, causes, hospital costs and perioperative outcomes of index vs nonindex hospital readmissions after radical cystectomy. Materials and Methods The 2013 Nationwide Readmissions Database was queried for patients with bladder cancer undergoing cystectomy. Sociodemographic characteristics, hospital costs and causes of readmission were compared among index and nonindex readmitted patients. Univariable and multivariable logistic regression models were used to identify predictors of nonindex readmissions, mortality during the first readmission and subsequent readmission. Results Among 4,991 patients identified 29{\%} (1,447) and 11{\%} (571) experienced an index and nonindex readmission, respectively. Compared to index readmissions, nonindex readmissions were more likely late readmissions (p <0.001) of older patients (p=0.047) who underwent cystectomy at higher volume hospitals (p=0.02) and were readmitted to hospitals located in less populated areas (p <0.001). Compared to index readmissions the percentage of nonindex readmissions for cardiovascular complications was higher (7.6{\%} vs 2.9{\%}, p=0.003), while the percentage of nonindex readmissions for gastrointestinal (6.0{\%} vs 11.0{\%}, p=0.04) and wound (5.3{\%} vs 16.7{\%}, p=0.0001) complications was lower. Predictors of nonindex readmission included longer length of stay (OR 1.02; 95{\%} CI 1.001, 1.04), patient location in less populated areas, nonteaching hospital (OR 0.52; 95{\%} CI 0.31, 0.86) and discharge to facility (OR 2.82; 95{\%} CI 1.75, 4.55) or with home health (OR 1.49; 95{\%} CI 1.05, 2.10). Nonindex readmissions had comparable mean readmission hospital costs ($14,147 vs $15,102, p=0.7), in-hospital mortality (OR 1.11; 95{\%} CI 0.42, 2.87) and subsequent readmission (OR 1.32; 95{\%} CI 0.87, 2.00) to index readmissions. Conclusions This nationally representative study of patients undergoing radical cystectomy demonstrated comparable perioperative outcomes and hospital costs between index and nonindex readmitted patients, which supports the continued regionalization of cystectomy care.",
keywords = "continuity of patient care, cystectomy, patient readmission, postoperative care, urinary bladder neoplasms",
author = "Chappidi, {Meera R.} and Max Kates and Stimson, {C. J.} and Michael Johnson and Pierorazio, {Phillip Martin} and Trinity Bivalacqua",
year = "2017",
month = "2",
day = "1",
doi = "10.1016/j.juro.2016.08.082",
language = "English (US)",
volume = "197",
pages = "296--301",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Causes, Timing, Hospital Costs and Perioperative Outcomes of Index vs Nonindex Hospital Readmissions after Radical Cystectomy

T2 - Implications for Regionalization of Care

AU - Chappidi, Meera R.

AU - Kates, Max

AU - Stimson, C. J.

AU - Johnson, Michael

AU - Pierorazio, Phillip Martin

AU - Bivalacqua, Trinity

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Purpose We compared the timing, causes, hospital costs and perioperative outcomes of index vs nonindex hospital readmissions after radical cystectomy. Materials and Methods The 2013 Nationwide Readmissions Database was queried for patients with bladder cancer undergoing cystectomy. Sociodemographic characteristics, hospital costs and causes of readmission were compared among index and nonindex readmitted patients. Univariable and multivariable logistic regression models were used to identify predictors of nonindex readmissions, mortality during the first readmission and subsequent readmission. Results Among 4,991 patients identified 29% (1,447) and 11% (571) experienced an index and nonindex readmission, respectively. Compared to index readmissions, nonindex readmissions were more likely late readmissions (p <0.001) of older patients (p=0.047) who underwent cystectomy at higher volume hospitals (p=0.02) and were readmitted to hospitals located in less populated areas (p <0.001). Compared to index readmissions the percentage of nonindex readmissions for cardiovascular complications was higher (7.6% vs 2.9%, p=0.003), while the percentage of nonindex readmissions for gastrointestinal (6.0% vs 11.0%, p=0.04) and wound (5.3% vs 16.7%, p=0.0001) complications was lower. Predictors of nonindex readmission included longer length of stay (OR 1.02; 95% CI 1.001, 1.04), patient location in less populated areas, nonteaching hospital (OR 0.52; 95% CI 0.31, 0.86) and discharge to facility (OR 2.82; 95% CI 1.75, 4.55) or with home health (OR 1.49; 95% CI 1.05, 2.10). Nonindex readmissions had comparable mean readmission hospital costs ($14,147 vs $15,102, p=0.7), in-hospital mortality (OR 1.11; 95% CI 0.42, 2.87) and subsequent readmission (OR 1.32; 95% CI 0.87, 2.00) to index readmissions. Conclusions This nationally representative study of patients undergoing radical cystectomy demonstrated comparable perioperative outcomes and hospital costs between index and nonindex readmitted patients, which supports the continued regionalization of cystectomy care.

AB - Purpose We compared the timing, causes, hospital costs and perioperative outcomes of index vs nonindex hospital readmissions after radical cystectomy. Materials and Methods The 2013 Nationwide Readmissions Database was queried for patients with bladder cancer undergoing cystectomy. Sociodemographic characteristics, hospital costs and causes of readmission were compared among index and nonindex readmitted patients. Univariable and multivariable logistic regression models were used to identify predictors of nonindex readmissions, mortality during the first readmission and subsequent readmission. Results Among 4,991 patients identified 29% (1,447) and 11% (571) experienced an index and nonindex readmission, respectively. Compared to index readmissions, nonindex readmissions were more likely late readmissions (p <0.001) of older patients (p=0.047) who underwent cystectomy at higher volume hospitals (p=0.02) and were readmitted to hospitals located in less populated areas (p <0.001). Compared to index readmissions the percentage of nonindex readmissions for cardiovascular complications was higher (7.6% vs 2.9%, p=0.003), while the percentage of nonindex readmissions for gastrointestinal (6.0% vs 11.0%, p=0.04) and wound (5.3% vs 16.7%, p=0.0001) complications was lower. Predictors of nonindex readmission included longer length of stay (OR 1.02; 95% CI 1.001, 1.04), patient location in less populated areas, nonteaching hospital (OR 0.52; 95% CI 0.31, 0.86) and discharge to facility (OR 2.82; 95% CI 1.75, 4.55) or with home health (OR 1.49; 95% CI 1.05, 2.10). Nonindex readmissions had comparable mean readmission hospital costs ($14,147 vs $15,102, p=0.7), in-hospital mortality (OR 1.11; 95% CI 0.42, 2.87) and subsequent readmission (OR 1.32; 95% CI 0.87, 2.00) to index readmissions. Conclusions This nationally representative study of patients undergoing radical cystectomy demonstrated comparable perioperative outcomes and hospital costs between index and nonindex readmitted patients, which supports the continued regionalization of cystectomy care.

KW - continuity of patient care

KW - cystectomy

KW - patient readmission

KW - postoperative care

KW - urinary bladder neoplasms

UR - http://www.scopus.com/inward/record.url?scp=85008221250&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85008221250&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2016.08.082

DO - 10.1016/j.juro.2016.08.082

M3 - Article

C2 - 27545575

AN - SCOPUS:85008221250

VL - 197

SP - 296

EP - 301

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 2

ER -