Hospitalization Trends After Prostate and Bladder Surgery: Implications of Potential Payment Reforms

Jacobs, Bruce L.; Zhang, Yun; Tan, Hung Jui; Ye, Zaojun; Skolarus, Ted A.; Hollenbeck, Brent K.

doi:10.1016/j.juro.2012.08.182

Cited by 51 publications

(30 citation statements)

References 23 publications

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“…We confirmed the morbidity revealing a 22.8% readmission, 55.2% complication, and 2.3% in-hospital mortality rate, which is similar to other published series. [7][8][9]13,14 We also revealed that treatment at higher-volume centres or academic centres was not protective or predictive of readmission. Academic centres were less likely to discharge patients to PACFs, which may be protective.…”

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confidence: 70%

“…Radical cystectomy (RC) may face scrutiny since it is associated with complication rates up to 68% and readmission rates as high as 26% even when performed at centres of excellence. [7][8][9] Given this data, RC could be a target quality improvement area. Therefore, our objective was to determine patient-and provider-related factors associated with 30-day readmission after RC.…”

Section: Introductionmentioning

confidence: 99%

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Few modifiable factors predict readmission following radical cystectomy

Minnillo

Maurice

Schiltz

et al. 2015

CUAJ

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Introduction: We sought to determine the patient and providerrelated factors associated with readmission after radical cystectomy (RC) for bladder cancer. In this era of healthcare reform, hospital performance measures, such as readmission, are beginning to affect provider reimbursement. Given its high readmission rate, RC could be a target for quality improvement. Methods: We reviewed bladder cancer patients who underwent RC in California's State Inpatient Database (2005Database ( -2009) of the Healthcare Cost and Utilization Project. We examined patient-(e.g., race, discharge disposition) and provider-related factors (e.g., volume) and evaluated their association with 30-day readmission. Multivariable logistic regression was used to examine associations of interest. Results: Overall, 22.8% (n = 833) of the 3649 patients who underwent RC were readmitted within 30 days. Regarding disposition, 34.8%, 50.8%, and 12.2% were discharged home, home with home healthcare, and to a post-acute care facility (PACF), respectively. Within 30 days, 20.3%, 20.9%, and 42.3% were discharged home, home with home healthcare, and to a PACF were readmitted, respectively. African Americans (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.07-2.50), having ≥2 comorbidities (OR 1.42, 95% CI 1.06-1.91), receiving a neobladder (OR 1.45, 95% CI 1.09-1.93), and discharged to a PACF (OR 3.79, 95% CI 2.88-4.98) were independent factors associated with readmission. Hospital stays ≥15 days were associated with less readmission (OR 0.43, p = 0.0002). Procedure volume was not associated with complication, in-hospital mortality, or readmission. Conclusions: About one-fifth of patients undergoing RC are readmitted. Patients who are discharged to a PACF, African American, and who have more extensive comorbidities tend to experience more readmissions. Increased efforts with care coordination among these patients may help reduce readmissions.

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confidence: 70%

Section: Introductionmentioning

confidence: 99%

Few modifiable factors predict readmission following radical cystectomy

Minnillo

Maurice

Schiltz

et al. 2015

CUAJ

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“…At the same time, the incidence of VTE occurring in the outpatient setting is likely exacerbated by the significant decrease in hospital length of stay for both simple and complex urologic procedures over the last 2 decades. 24 With the continued push toward short hospitalization, patients may ultimately suffer more from the potentially deadly complications of VTEs that develop outside the purview of the inpatient setting.…”

Section: Commentmentioning

confidence: 99%

Venous Thromboembolism After Major Urologic Oncology Surgery: A Focus on the Incidence and Timing of Thromboembolic Events After 27,455 Operations

Alberts

Woldu

Weinberg

et al. 2014

Urology

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“…Others have similarly shown that in the area of gastrointestinal resections and general surgery procedures, postoperative complications are significantly associated with hospital readmissions [17,23e26]. Likewise, in the area of orthopedics and plastic surgery, recent publications identified adverse events and procedure type as independent [20,31,32]. Besides the concern of applying a single readmission benchmark to all surgical procedures, some have argued that hospital readmission is a poor metric and not adequate to assess quality of care delivered [33e40].…”

Section: Discussionmentioning

confidence: 99%