Timing, Patterns and Predictors of 90-days Readmission Rate after Robotic Radical Cystectomy

Bladder Cancer
10/10/2020

J Urol. 2020 Oct 9:101097JU0000000000001387. doi: 10.1097/JU.0000000000001387. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the timing, patterns and predictors of 90-day readmission after robotic radical cystectomy.

METHODS: From September 2009 to March 2017, 271 consecutive patients undergoing robotic radical cystectomy (RRC) with intent to cure bladder cancer (intracorporeal diversion N=253, 93%) were identified from our prospectively collated institutional database. Readmission was defined as any subsequent inpatient admission or unplanned visit occurring within 90-days from discharge after the index hospitalization. Multiple readmissions were defined as ≥ 2 readmissions within 90-days period. Logistic regression analysis was used to identify independent factors related to single and multiple 90-days readmission.

RESULTS: A total of 78 (28.8%) patients were readmitted at least once within 90-days after discharge of whom 20 (25.6%) patients reported multiple readmissions. The cumulative duration of readmission was 6.2 (6.17) days with 6 (7.6%) patients having <24 hours readmission. Metabolic, infectious, genitourinary and gastrointestinal complications were identified as primary cause of readmission in 39.5%, 23.5%, 22.3% and 17%, respectively. Fifty percent readmissions occurred in the first two weeks after hospital discharge. On multivariable logistic-regression analysis, in-hospital infections (OR:2.85;p=0.001) were independent predictors for overall readmission. Male gender (OR:3.5; p=0.02) and in hospital infections (OR:4.35;p=0.002) were independent predictors for multiple readmissions.

CONCLUSION: The 90-day readmission rate following robotic radical cystectomy is significant. In-hospital infections and male gender were independent factors for readmission. Most readmissions occurred in the first 2 weeks following discharge, with metabolic derrangements and infections being the most common causes.