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MP24-19 PATTERNS OF CARE FOR READMISSION FOLLOWING RADICAL CYSTECTOMY IN NEW YORK STATE: DOES THE HOSPITAL MATTER?
THE JOURNAL OF UROLOGYâ
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CONCLUSIONS: Hospital readmissions within 90 days of major urologic cancer surgery are associated with a low FTR rate; however, patients readmitted to a SH experienced higher FTR than those readmitted to their original hospital. These findings may inform clinical decision-making around hospital transfers and aid future quality improvement initiatives to reduce the morbidity associated with complex urologic oncology surgeries. Source of Funding: None
MP24-19 PATTERNS OF CARE FOR READMISSION FOLLOWING RADICAL CYSTECTOMY IN NEW YORK STATE: DOES THE HOSPITAL MATTER? Jamie S. Pak*, Danny Lascano, Daniel Kabat, Julia B. Finkelstein, Mark V. Silva, G. Joel DeCastro, William Gold, James M. McKiernan, New York, NY INTRODUCTION AND OBJECTIVES: Radical cystectomy (RC) is a notoriously morbid procedure, leading to high rates of postoperative complications and hospital readmission. The Statewide Planning and Research Cooperative System (SPARCS) is a comprehensive all-payer database maintained by the New York State (NYS) Department of Health on inpatient and outpatient visits of NYS residents. The aim of this study was to describe the patterns of care for 30and 90-day readmissions after RC and to determine if readmission to the original hospital (OH) versus an outside hospital (OSH) had an impact on outcomes. METHODS: The SPARCS database was queried for all RCs with discharges between 1/1/2009 and 9/31/2012 in NYS. Readmissions at 30 and 90 days were stratified into OH versus OSH, and outcomes were analyzed accordingly. Chi-square analysis and t-test were utilized to compare patient characteristics and outcomes. RESULTS: During the study period, 2338 NYS residents were discharged after RC. Overall rate of readmission was 28.1% within 30 days and 39.2% within 90 days. Readmitted patients were more commonly male (90.0% vs. 85.3%, p¼0.001). Age, race, and primary payer were not significantly different between readmitted and nonreadmitted patients. The percentage of all readmitted patients who were readmitted to OH was 80.4% and 77.1% within 30 and 90 days, respectively. Patients readmitted to OH vs. OSH were younger (30day weighted average median value [WAMV] of 68.8 vs. 73.1, p<0.0005; 90-day WAMV of 69.2 vs. 73.4, p<0.0005) and had a lower All Patient Refined Severity of Illness (APRSI) (30-day: p¼0.047, 90-day: p¼0.004), but had longer lengths of stay at readmission (30-day WAMV of 5.3 vs. 4.3 days, p<0.0005; 90-day WAMV of 5.4 vs. 4.9 days, p<0.0005). However, patients readmitted to OSH had higher rates of multiple readmissions (45.7% vs. 35.4%, p¼0.007) and ICU stays (18.7% vs. 12.0%, p¼0.002) at 90 days. Patients readmitted to OSH within 30 days of RC were also 3.62 times more likely to die than those readmitted to OH (95% CI 1.538.58, p<0.005). Gender, race, APR Risk of Mortality (APRRM), and primary payer were not significantly different between OH and OSH readmissions. CONCLUSIONS: Patients readmitted to OSH within 30 days of RC were over 3 times more likely to die than those readmitted to OH. Potential drivers of worse outcomes at OSH are higher acuity of admitting diagnosis, lower quality or fewer resources at OSH, and less familiarity of the hospital staff with the patient. Individual patient analysis
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
is needed to further elucidate the drivers leading to worse outcomes at readmission to OSH vs. OH after RC. Source of Funding: None
MP24-20 CAUSES OF HOSPITAL READMISSIONS AFTER UROLOGIC CANCER SURGERY Marianne Schmid*, Hamburg, Germany; Abraham Chiang, Boston, MA; Akshay Sood, Logan Campbell, Detroit, MI; Felix Chun, Hamburg, Germany; Deepansh Dalela, Detroit, MI; James Okwara, Boston, MA; Jesse Sammon, Detroit, MI; Adam Kibel, Boston, MA; Mani Menon, Detroit, MI; Margit Fisch, Hamburg, Germany; Quoc-Dien Trinh, Boston, MA INTRODUCTION AND OBJECTIVES: The Hospital Readmissions Reduction Program mandates reimbursement reductions to hospitals with higher than expected rates of readmissions. We examine causes and predictors of readmissions following major procedures in urologic oncology. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, patients undergoing radical prostatectomy (RP), radical (RN) or partial nephrectomy (PN), and radical cystectomy (RC) during the year 2012 were abstracted. Rates of unplanned readmission within 30 days after surgery, as well as causes of readmission, were identified. Multivariable logistic regression models were fitted to examine the association between patient perioperative factors and odds of readmission. RESULTS: 0-day readmission rates for patients treated with RP, RN, PN and RC were 4.1, 5.2, 4.5 and 15.9%, respectively. Commonest causes of readmission after RP included thromboembolic (13.6%), wound (12.2%), renal/genitourinary (12.2%), and gastrointestinal (11.8%), after RN wound (12.9%) and gastrointestinal (12.9%), after PN renal/genitourinary (19.6%), cardiovascular (9.8%) and bleeding/hematoma (9.8%) and after RC renal/genitourinary (15.5%), wound (14.8%) and sepsis/infection (14.1%). Patients undergoing open RP or PN, were more likely to be readmitted relative to their minimally invasive counterparts (OR: 1.53, 95% CI: 1.12-2.08, p¼0.007 and OR: 2.51, 95% CI: 1.38-4.55, p¼0.003, respectively). CONCLUSIONS: Readmissions are relatively common following major urologic oncology procedures. Venous thromboembolism is a common modifiable cause of readmission following urologic cancer surgery. RC patients experience a rapid increase in readmission rates following discharge and experience a high burden of readmission. Minimally invasive approach is associated with decreased odds of readmission following RP and PN.
Source of Funding: none
e284
CONCLUSIONS: Hospital readmissions within 90 days of major urologic cancer surgery are associated with a low FTR rate; however, patients readmitted to a SH experienced higher FTR than those readmitted to their original hospital. These findings may inform clinical decision-making around hospital transfers and aid future quality improvement initiatives to reduce the morbidity associated with complex urologic oncology surgeries. Source of Funding: None
MP24-19 PATTERNS OF CARE FOR READMISSION FOLLOWING RADICAL CYSTECTOMY IN NEW YORK STATE: DOES THE HOSPITAL MATTER? Jamie S. Pak*, Danny Lascano, Daniel Kabat, Julia B. Finkelstein, Mark V. Silva, G. Joel DeCastro, William Gold, James M. McKiernan, New York, NY INTRODUCTION AND OBJECTIVES: Radical cystectomy (RC) is a notoriously morbid procedure, leading to high rates of postoperative complications and hospital readmission. The Statewide Planning and Research Cooperative System (SPARCS) is a comprehensive all-payer database maintained by the New York State (NYS) Department of Health on inpatient and outpatient visits of NYS residents. The aim of this study was to describe the patterns of care for 30and 90-day readmissions after RC and to determine if readmission to the original hospital (OH) versus an outside hospital (OSH) had an impact on outcomes. METHODS: The SPARCS database was queried for all RCs with discharges between 1/1/2009 and 9/31/2012 in NYS. Readmissions at 30 and 90 days were stratified into OH versus OSH, and outcomes were analyzed accordingly. Chi-square analysis and t-test were utilized to compare patient characteristics and outcomes. RESULTS: During the study period, 2338 NYS residents were discharged after RC. Overall rate of readmission was 28.1% within 30 days and 39.2% within 90 days. Readmitted patients were more commonly male (90.0% vs. 85.3%, p¼0.001). Age, race, and primary payer were not significantly different between readmitted and nonreadmitted patients. The percentage of all readmitted patients who were readmitted to OH was 80.4% and 77.1% within 30 and 90 days, respectively. Patients readmitted to OH vs. OSH were younger (30day weighted average median value [WAMV] of 68.8 vs. 73.1, p<0.0005; 90-day WAMV of 69.2 vs. 73.4, p<0.0005) and had a lower All Patient Refined Severity of Illness (APRSI) (30-day: p¼0.047, 90-day: p¼0.004), but had longer lengths of stay at readmission (30-day WAMV of 5.3 vs. 4.3 days, p<0.0005; 90-day WAMV of 5.4 vs. 4.9 days, p<0.0005). However, patients readmitted to OSH had higher rates of multiple readmissions (45.7% vs. 35.4%, p¼0.007) and ICU stays (18.7% vs. 12.0%, p¼0.002) at 90 days. Patients readmitted to OSH within 30 days of RC were also 3.62 times more likely to die than those readmitted to OH (95% CI 1.538.58, p<0.005). Gender, race, APR Risk of Mortality (APRRM), and primary payer were not significantly different between OH and OSH readmissions. CONCLUSIONS: Patients readmitted to OSH within 30 days of RC were over 3 times more likely to die than those readmitted to OH. Potential drivers of worse outcomes at OSH are higher acuity of admitting diagnosis, lower quality or fewer resources at OSH, and less familiarity of the hospital staff with the patient. Individual patient analysis
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
is needed to further elucidate the drivers leading to worse outcomes at readmission to OSH vs. OH after RC. Source of Funding: None
MP24-20 CAUSES OF HOSPITAL READMISSIONS AFTER UROLOGIC CANCER SURGERY Marianne Schmid*, Hamburg, Germany; Abraham Chiang, Boston, MA; Akshay Sood, Logan Campbell, Detroit, MI; Felix Chun, Hamburg, Germany; Deepansh Dalela, Detroit, MI; James Okwara, Boston, MA; Jesse Sammon, Detroit, MI; Adam Kibel, Boston, MA; Mani Menon, Detroit, MI; Margit Fisch, Hamburg, Germany; Quoc-Dien Trinh, Boston, MA INTRODUCTION AND OBJECTIVES: The Hospital Readmissions Reduction Program mandates reimbursement reductions to hospitals with higher than expected rates of readmissions. We examine causes and predictors of readmissions following major procedures in urologic oncology. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, patients undergoing radical prostatectomy (RP), radical (RN) or partial nephrectomy (PN), and radical cystectomy (RC) during the year 2012 were abstracted. Rates of unplanned readmission within 30 days after surgery, as well as causes of readmission, were identified. Multivariable logistic regression models were fitted to examine the association between patient perioperative factors and odds of readmission. RESULTS: 0-day readmission rates for patients treated with RP, RN, PN and RC were 4.1, 5.2, 4.5 and 15.9%, respectively. Commonest causes of readmission after RP included thromboembolic (13.6%), wound (12.2%), renal/genitourinary (12.2%), and gastrointestinal (11.8%), after RN wound (12.9%) and gastrointestinal (12.9%), after PN renal/genitourinary (19.6%), cardiovascular (9.8%) and bleeding/hematoma (9.8%) and after RC renal/genitourinary (15.5%), wound (14.8%) and sepsis/infection (14.1%). Patients undergoing open RP or PN, were more likely to be readmitted relative to their minimally invasive counterparts (OR: 1.53, 95% CI: 1.12-2.08, p¼0.007 and OR: 2.51, 95% CI: 1.38-4.55, p¼0.003, respectively). CONCLUSIONS: Readmissions are relatively common following major urologic oncology procedures. Venous thromboembolism is a common modifiable cause of readmission following urologic cancer surgery. RC patients experience a rapid increase in readmission rates following discharge and experience a high burden of readmission. Minimally invasive approach is associated with decreased odds of readmission following RP and PN.
Source of Funding: none