Introduction

Recent policy efforts have focused on bundling payments across multiple providers for acute inpatient hospitalization and 90 days after hospital discharge. Given the volume and financial impact, radical prostatectomy (RP) will likely be targeted as episode-based payment policies expand. To date, there are no studies investigating non-index readmissions (hospital that did not perform the surgery) during 90-day RP episodes. Our objective was to compare the causes, outcomes, and hospital costs of patients with index vs. non-index readmissions following RP to better understand the impact of non-index readmissions in the 90-day RP episode.

Methods

The 2013 Nationwide Readmissions Database was queried for prostate cancer patients undergoing RP. Sociodemographic characteristics, hospital costs, and causes of readmission were compared among index and non-index readmitted patients. Multivariable logistic regression models used to identify predictors of index, non-index, and subsequent readmission, prolonged length of stay (pLOS) upon readmission, and high-cost readmission.

Results

While 5.4%(2154/39892) of patients were readmitted, their care accounted for 10.4% of perioperative (90 day) hospital costs. Compared to index readmissions (n=1505), non-index readmissions (n=649) were more likely from high-volume RP centers (OR=2.18, 95%CI[1.06-4.50]). Non-index readmissions had higher average readmission costs ($11,903 vs. $9,447, p=0.02) and increased odds of high-cost readmission (OR=1.78, 95%CI[1.22-2.60]), but comparable odds of pLOS (OR=1.39, 95%CI[0.94-2.01]), subsequent readmission (OR=1.56, 95%CI[0.92-2.63]) and in-hospital mortality rates (0% vs. 0.2%, p=0.4). Among gastrointestinal complication patients, non-index readmissions had higher rates of laparotomy/laparoscopy (17% vs. 2.9%, p=0.01).

Conclusions

This nationally representative study of RP patients demonstrates non-index readmissions are associated with comparable outcomes but higher hospital costs than index readmissions likely associated with differences in the rate and/or type of operative management. The benefits of undergoing RP at high-volume centers should be carefully balanced with the increased odds of non-index readmissions and higher costs associated with them. As payers, providers, and patients continue to look for cost containment strategies and bundle the 90-day post hospitalization period, non-index readmissions are a potential target to decrease healthcare costs for RP patients.

Funding

none