Oncology - Bladder, Renal, Test
Mid-Atlantic Section 76th Annual Meeting
Introduction & Objective : Radical Cystectomy is a complex oncologic procedure that is often performed at larger academic institutions. For many parts of the country, this requires patients to travel significant distances to undergo their procedure. We aimed to examine the association between travel distance to a cystectomy center and readmission patterns.
Methods : Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients underwent radical cystectomy as part of the treatment of bladder cancer between 2004 and 2011. Patients were grouped into quartiles according to travel distance to the cystectomy center where the patient’s cystectomy was performed (close, moderately close, moderately far, and far). The relationship between distance to a cystectomy center and readmission was assessed using a multivariable logistic regression model. Survival was assessed using Cox models.
Results : Among 4556 patients who underwent cystectomy, 1857 (41%) were readmitted and 243 (5%) died without being readmitted within 90 days. Compared to patients who lived close to cystectomy center, those who lived moderately close were the most likely to get readmitted (OR 1.22, CI 1.03-1.44; p= 0.02). No difference in readmission was observed in the moderately far or far quartiles. Interestingly as travel distance increased, patients were less likely to return to the index hospital from readmission (p<0.001). Differences were observed between distance quartiles in overall or disease-specific survival (both p<0.001) with improved survival observed with increasing travel distance.
Our findings demonstrate that cystectomy remains a complex procedure with high readmission rates. A complex relationship between travel distance and readmission rates exist. Increasing travel distance decreases the likelihood of the patient to return to the index hospital for readmission. Future efforts should focus on understanding ways to decrease readmissions and improve mortality.