Presentation Authors: Meera Chappidi*, San Francisco, CA, Max Kates, Trinity Bivalacqua, Baltimore, MD, Anobel Odisho, San Francisco, CA
Introduction: Recent work has demonstrated care fragmentation (CF), such as readmission to hospitals that did not perform the surgery (non-index), may result in worse patient outcomes. Our objective was to analyze trends in readmission and CF rates following major urologic oncology surgeries to better understand the burden of CF in urologic oncology and characterize recent trends over time.
Methods: Patients who underwent cystectomy (RC), prostatectomy (RP), nephrectomy (RN), partial nephrectomy (PN), nephroureterectomy (NU), and retroperitoneal lymph node dissection (RPLND) were identified in the 2010-2014 Nationwide Readmissions Database. Among readmitted patients, CF was defined as a readmission to a non-index hospital in 90-day follow-up after surgery. Ninety-day readmission and CF rates were compared across time within each procedure using univariable and multivariable logistic regression.
Results: Overall, 90-day readmission rates were (Figure) 40.3% for RC (n=9,964), 5.8% for RP (n=12,341), 14.9% for RN (n=11,542), 14.0% for PN (n=6,419), 17.6% for NU (n=2,431), and 18.1% for RPLND (n=321). In multivariable models controlling for: x y z, PN was the only surgery with a significant decrease in 90-day readmission rates over time (OR=0.94 per year, 95%CI 0.91-0.98, ptrend=0.002). Among readmitted patients, 90-day CF rates were 33.3% for RC, 32.1% for RP, 32.0% for RN, 28.1% for PN, 33.0% for NU, and 26.2% for RPLND. In multivariable models, 90-day CF rates did not significantly change over time for any of the surgeries (all p>0.05).
Conclusions: This is the first study to investigate trends in nationally representative estimates of readmission and CF rates following major urologic oncology surgeries. PN was the only procedure with improved readmission rates over time. For all other procedures studied, readmission and CF rates have not improved over recent years. There was no single predictor of 90-day readmission or CF that was consistent across all surgeries, highlighting each surgery likely requires an individualized approach to improve readmission rates. Furthermore, since CF rates have been consistent in recent years, future efforts should focus on better understanding the impact of CF on patient outcomes following major urologic oncology surgeries.