Introduction

A key priority of the Michigan Urological Surgery Improvement Collaborative (MUSIC) is to improve perioperative outcomes after radical prostatectomy (RP). MUSIC has previously developed a novel metric, Notable Outcomes and Trackable Events after Surgery (NOTES) to facilitate objective unambiguous tracking of deviations from an uncomplicated recovery pathway. Readmission within 30 days represents a significant, potentially avoidable morbid deviation for the patient and can have financial implications. This study aims to utilize NOTES to assess the relationship between length of stay (LOS) and readmission and identify the key drivers of 30 day readmission after RP.

Methods

For men undergoing RP from April 1, 2014 to the present, trained abstractors in 43 MUSIC practices prospectively recorded clinical and peri-operative data in an electronic registry. All cases with a 30 day readmission were identified via deviation from the NOTES pathway. Precipitating events for these deviations were recorded by abstractors.

Results

A total of 4710 RPs were performed by 209 surgeons in 41 participating MUSIC practices. Thirty day readmission rates were 4.1% overall, 3.8% for those with LOS 0-2 days and 7.1% for those with LOS ≥3 days. The most frequent events driving readmission were gastrointestinal (GI) events such as ileus or bowel injury (24.5%), infection (19.8%), urine leaks (13.0%) and pulmonary embolism (PE)/deep vein thrombosis (DVT) (12.5%) (Table 1). GI events resulted in 56.3% of readmissions within 3 days of discharge (Figure 1). Infection, urine leaks and PE/DVT remained persistent drivers beyond this period (Figure 1).

Conclusions

GI and urine complications represent the majority of drivers resulting in 30 day readmission. Measures to specifically reduce these by appropriate patient education and close post-discharge surveillance may represent a high impact opportunity for quality improvement efforts after RP.

Funding

Blue Cross and Blue Shield of Michigan