Login to Access Video or Poster Abstract: MP21-09
Sources of Funding: None

Introduction

Clinical decision making regarding timing of discharge can vary widely for patients treated with radical cystectomy. Some patients may be kept in-house longer to diminish perceived risk of missed complications and subsequent readmission. We sought to evaluate the relationship between length of stay (LOS) and 30-day readmissions in patients who underwent radical cystectomy and did not experience in-hospital complications.

Methods

We used data from the American College of Surgeons National Surgical Quality Improvement Program to identify bladder cancer patients who underwent radical cystectomy (2011-2014), and excluded patients who experienced in-hospital complications. Our primary outcome of interest was 30-day readmission, and main exposure was LOS in days (<6, 6-10, >10 days). Other factors of interest included race, gender, major complications after discharge, body mass index, and operative time (stratified by quartiles). Multivariable logistic regression was performed to estimate adjusted odds ratios for 30-day readmission.

Results

Among 3,325 radical cystectomy patients who had an uncomplicated hospital stay, 718 (21.6%) were readmitted within 30 days after surgery. The median initial LOS was 7.0 days (interquartile range 6.0-9.0 days). A majority were discharged either between 6-10 days (42.1%) or >10 days after surgery (21.3%). Readmission was more common among patients who had post-discharge complications (35.1% vs 11.9% no complications, p<0.001) and increased operative time (29.7% top quartile vs 15.9% lowest quartile, p<0.001). Though readmitted patients had a shorter initial LOS on average (mean 7.8±3.0 vs 8.4±4.8 days no readmission, p=0.003), there was no significant relationship after adjusting for other factors (20.6% 0-6 days vs 19.5% 10+ days, adjusted OR 1.03, 95% 0.79-1.35, Figure). A subset analysis examining only surgery-related readmissions demonstrated similar findings.

Conclusions

If no in-hospital complications occur following radical cystectomy, applying arbitrary minimum thresholds for length of stay may not decrease the risk of hospital readmission.

Funding

None