Open Access

ARTICLE

Readmissions after major urologic cancer surgery

Jeffrey J. Leow¹, Giorgio Gandaglia², Akshay Sood³, Nedim Ruhotina¹, Dane E. Klett³, Jesse D. Sammon³, Marianne Schmid⁴, Maxine Sun⁵, Steven L. Chang¹, Adam S. Kibel¹, Quoc-Dien Trinh¹

1 Center for Surgery and Public Health and Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
2 Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Urological Research Institute, Milan, Italy
3 VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
4 Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
5 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
Address correspondence to Dr. Jeffrey J. Leow, Center for Surgery and Public Health, Brigham and Women’s Hospital, One Brigham Circle, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120 USA

Canadian Journal of Urology 2014, 21(6), 7537-7546.

Abstract

Introduction: We examine the incidence and predictors of readmission after major urologic cancer surgery using a national, prospective-maintained database specifically developed to assess quality of surgical care.
Materials and methods: Patients undergoing major urologic cancer surgery (radical prostatectomy [RP], radical nephrectomy [RNx], partial nephrectomy [PNx]), radical cystectomy [RC]) in 2011 were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) using Current Procedural Terminology (CPT) codes. Those readmitted within 30 days after surgery were identified. Multivariable logistic regression models examined the association between patient characteristics and the odds of readmission.
Results: Overall, we identified 5356 RP, 1301 RNx, 918 PNx and 623 RC patients, of which 206 (3.8%), 533 (6.8%), 348 (6.3%) and 129 (20.7%) were readmitted within 30 days respectively. Independent predictors of readmission for RP included age (Odds Ratio [OR]: 1.02, p = 0.02), American Society of Anesthesiology (ASA) score 3-5 (versus 1-2, OR: 1.35, p = 0.04), smoking status (OR: 1.53, p = 0.04), and the occurrence of wound complications (OR: 9.31, p < 0.001), thromboembolic (OR: 14.7, p < 0.001), and renal failure (OR: 1.62, p = 0.01) complications during the index hospitalization. For RC patients, the only predictor of readmission was age (OR: 0.98, p = 0.04). Predictors of readmission for RNx included higher ASA score (OR: 1.77, p = 0.03), and the presence of any complications during the index hospitalization (OR: 2.21, p = 0.03).
Conclusions: Several patient characteristics have a significant impact on the risk of 30 day readmission after major urologic cancer surgery. Our data suggests that improving prevention and management of complications during the index hospitalization may lead to a substantial decrease in readmission rates.

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