Presentation Authors: Abhinav Khanna*, Anna Zampini, Alice Crane, Byron Lee, Georges-Pascal Haber, Cleveland, OH
Introduction: Radical cystectomy (RC) has the highest hospital readmission rate of all urologic surgeries. Enhanced recovery (ER) pathways have demonstrated reductions in inpatient length of stay, but have limited impact on hospital readmissions. We aim to assess readmission outcomes of a traditional ER pathway as well as a targeted post-discharge intervention aimed at reducing hospital readmissions following RC.
Methods: A prospectively maintained clinical database was used to identify patients undergoing RC before and after implementation of an ER protocol at our institution. An additional intervention aimed at reducing hospital readmission included close post-discharge follow-up and outpatient intravenous hydration (ER+). Inpatient length of stay (LOS) and readmission rates were compared between groups using Wilcoxon Rank Sum and chi-square, respectively. Univariate and multivariate logistic regression was used to identify factors associated with hospital readmission.
Results: A total of 320 patients underwent RC, including 111 and 209 patients before and after ER implementation. Median (IQR) LOS decreased from 8.0 (6.0-11.0) days to 5.0 (4.0-7.0) days following ER implementation (p < 0.0001). Readmissions, however, were unchanged following ER implementation (p=0.49). An additional targeted readmission reduction intervention (ER+) was associated with significantly reduced hospital readmissions compared to traditional ER alone (ER+ 5.9%, traditional ER 20.3%, p=0.017).
Conclusions: ER protocols consistently demonstrate reductions in LOS, and should be the standard of care following RC. In order to reduce hospital readmissions, the urologic community must expand beyond traditional ER pathways. We report significant reductions in hospital readmission among RC patients receiving a targeted post-discharge intervention beyond traditional ER alone.