Purpose

Hospital readmission is associated with adverse outcomes and increased cost, and as such, has been identified as a metric for surgical quality and a target for shifts in health policy. However, the disposition of patients who undergo radical cystectomy for bladder cancer and the association between discharge locations and readmission rates is poorly understood. Understanding the patterns and characteristics of readmission after radical cystectomy will help inform discharge planning and expectations and may have long-term impacts on quality and cost of care delivery. We hypothesize that patients will have varying readmission rates based on their discharge location.

Materials and methods

An observational analysis of the Nationwide Readmissions Database was performed for all patients who underwent elective radical cystectomy in 2016 to 2017. The patients were grouped by the following criteria: whether they were discharged home, home with care, or to a facility. Univariate analysis was performed using the Chi-square test for categorical variables and the Kruskal-Wallis test for continuous variables. A multivariable logistic regression was conducted to evaluate if discharge locations impact patient readmissions at 30- and 90-days.

Results

The final dataset included 4,947 patients discharged home with care, 2,127 patients discharged to home or self-care, and 1,232 patients discharged to a facility. Discharge to a facility was strongly associated with higher 30-day (OR 1.49, CI 1.26−1.76) and 90-day readmission rates (OR 1.46, CI 1.23−1.74). Additionally, home health care was strongly associated with increased 30-day readmission rates (OR 1.22, CI 1.08−1.37) relative to routine discharge home.

Conclusions

Our analysis suggests that discharge location independently predicts readmission following RC. Further study with more granular patient- and system-level data may aid in identifying structural characteristics and processes that can reduce readmissions and their associated economic impact, while maintaining quality of care delivered.

中文翻译：

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出院位置对根治性膀胱切除术后结果的影响

目的

再入院与不良后果和成本增加有关，因此，已被确定为衡量手术质量的指标和卫生政策转变的目标。然而，对于因膀胱癌而接受根治性膀胱切除术的患者的情况以及出院地点与再入院率之间的关系却知之甚少。了解根治性膀胱切除术后再入院的模式和特征将有助于制定出院计划和期望，并可能对护理质量和成本产生长期影响。我们假设患者的再入院率会因出院地点而异。

材料和方法

对 2016 年至 2017 年接受择期根治性膀胱切除术的所有患者进行了全国再入院数据库的观察性分析。这些患者按以下标准分组：他们是出院回家、在家接受护理还是去设施。对分类变量使用卡方检验，对连续变量使用 Kruskal-Wallis 检验进行单变量分析。进行多变量逻辑回归以评估出院地点是否会影响患者在 30 天和 90 天时的再入院。

结果

最终数据集包括 4,947 名出院回家护理的患者、2,127 名出院回家或自行护理的患者以及 1,232 名出院到机构的患者。出院与较高的 30 天（OR 1.49，CI 1.26-1.76）和 90 天再入院率（OR 1.46，CI 1.23-1.74）密切相关。此外，与常规出院回家相比，家庭保健与增加的 30 天再入院率（OR 1.22，CI 1.08-1.37）密切相关。

结论

我们的分析表明，出院位置独立预测 RC 后的再入院。使用更细化的患者和系统级数据进行进一步研究可能有助于确定可以减少再入院及其相关经济影响的结构特征和过程，同时保持提供的护理质量。