Introduction

Radical cystectomy for bladder cancer is performed in an aged, highly comorbid population, and associated with high rates of readmission. We investigated the LACE score, a validated prediction tool for readmission and mortality, in the radical cystectomy population._x000D_

Methods

Patients who underwent radical cystectomy for bladder cancer were identified by ICD-9 codes from the Healthcare Cost and Utilization Project State Inpatient Database for California between years 2007-2010. The LACE score was calculated as previously described, with components of L: length of stay, A: acuity of admission, C: comorbidity, and E: number of emergency department visits within 6 months preceding surgery (Figure). Descriptive statistics were performed, and multivariable logistic regression models were fit in a non-parsimonious fashion, including all patient demographic and clinical variables, in order to isolate the effect of the LACE score on outcomes (90-day readmission and mortality).

Results

Of 3,470 radical cystectomy patients, 638 (18.4%) experienced 90-day readmission, and 160 (4.6%) 90-day mortality. At a previously validated 'high-risk' LACE score ≥ 10, patients experienced an increased risk of 90-day readmission (22.8% vs 17.7%, p=0.002) and mortality (9.1% vs 3.5%, p<0.001). On adjusted multivariable analysis, 'high risk' patients by LACE score had increased 90-day odds of readmission (aOR=1.24, 95% CI: 0.99-1.54, p=0.050) and mortality (aOR=2.09, 95% CI: 1.47-2.99, p<0.001). Separate multivariate models demonstrated a one point increase in LACE score had a 7.3% increased adjusted odds of readmission, and a 33.2% increased odds of mortality.

Conclusions

The LACE score reasonably predicts patients at risk for 90-day readmission and mortality following radical cystectomy. Providers may use the LACE score to target high-risk patients for closer follow-up or intervention.

Funding

None