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• W3021836052 abstract "You have accessJournal of UrologyBladder Cancer: Invasive VI (PD60)1 Apr 2020PD60-12 DISCRETIONARY AND NECESSARY READMISSION AFTER RADICAL CYSTECTOMY Ahmet M Aydin*, Salim Cheriyan, Richard Reich, Ali Hajiran, Logan Zemp, Michael Poch, Brandon Manley, Philippe Spiess, Julio Pow-Sang, Wade Sexton, Roger Li, and Scott M Gilbert Ahmet M Aydin*Ahmet M Aydin* More articles by this author , Salim CheriyanSalim Cheriyan More articles by this author , Richard ReichRichard Reich More articles by this author , Ali HajiranAli Hajiran More articles by this author , Logan ZempLogan Zemp More articles by this author , Michael PochMichael Poch More articles by this author , Brandon ManleyBrandon Manley More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , Julio Pow-SangJulio Pow-Sang More articles by this author , Wade SextonWade Sexton More articles by this author , Roger LiRoger Li More articles by this author , and Scott M GilbertScott M Gilbert More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000977.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Complications and readmissions are common after radical cystectomy (RC) and urinary diversion and have been subject to extensive examination in efforts to improve recovery after surgery. However, it is unclear if readmissions after RC are mutable, even though ERAS programs are increasingly used in cystectomy care. Therefore, we examined indications for readmission to better understand the proportion that are discretionary vs. medically necessary and to estimate how responsive RC is to readmission reduction efforts. METHODS: Records for patients treated with cisplatin-based neoadjuvant chemotherapy followed by RC between 2007 and 2017 were reviewed for 90-day complications and readmission. Postoperative complications were categorized and assigned Clavien-Dindo grades and readmissions were classified as necessary or discretionary based on independent clinician review. The association between any and major complications and necessary or discretionary readmission were examined with adjusted regression models. RESULTS: A total of 250 patients were included in the analysis. There were 76 readmissions within 90 days of surgery (19 discretionary and 57 necessary). There were no differences in age, insurance coverage, or comorbidity between readmitted and non-readmitted patients. Readmission was more likely after neobladder than ileal conduit (39% vs. 23.7%, p=0.02). Major (grade ≥ 3) complications were more likely to result in necessary as opposed to discretionary readmissions (40% vs. 21% p<0.001), and median length of stay on readmission was twice as long in necessary cases compared to discretionary cases (2.5 vs. 5 days, p<0.001). Gastrointestinal (GI) and infectious complications were associated with discretionary readmission in adjusted analyses, while infectious, renal/genitourinary and thromboembolic complications were highly associated with necessary readmission (Table). CONCLUSIONS: Our findings indicate that the type and grade of complications influence both discretionary and necessary readmission. Notably, 25% of readmissions were categorized as discretionary and were driven primarily by low-grade GI complications, such as nausea, vomiting and marginal PO intake, suggesting that better coordinated post-discharge supportive care could help avoid a significant proportion of readmissions. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1279-e1279 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmet M Aydin* More articles by this author Salim Cheriyan More articles by this author Richard Reich More articles by this author Ali Hajiran More articles by this author Logan Zemp More articles by this author Michael Poch More articles by this author Brandon Manley More articles by this author Philippe Spiess More articles by this author Julio Pow-Sang More articles by this author Wade Sexton More articles by this author Roger Li More articles by this author Scott M Gilbert More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W3021836052 date "2020-04-01" @default.
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• W3021836052 title "PD60-12 DISCRETIONARY AND NECESSARY READMISSION AFTER RADICAL CYSTECTOMY" @default.
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