Readmission After Robot-assisted Radical Cystectomy: Outcomes and Predictors at 90-Day Follow-up

Abstract

OBJECTIVE To characterize the outcomes and predictors of readmission after robot-assisted radical cystectomy (RARC) during early (30-day) and late (31–90–day) postoperative periods. METHODS We retrospectively evaluated our prospectively maintained RARC quality assurance database of 272 consecutive patients operated between 2005 and 2012. We evaluated the relationship of readmission with perioperative outcomes and examined possible predictors during the postoperative period. RESULTS Overall 30- and 90-day mortality was 0.7% and 4.8%, respectively, with 25.5% patients readmitted within 90 days after RARC (61% of them were readmitted within 30 days and 39% were readmitted between 31–90 days postoperatively). Infection-related problems were the most common cause of readmission during early and late periods. Overall operative time and obesity were significantly associated with readmission (P = .034 and .033, respectively). Body mass index and female gender were independent predictors of 90-day readmission (P = .004 and .014, respectively). Having any type of complication correlated with 90-day readmission (P = .0045); meanwhile, when complications were graded on the basis of Clavien grading system, only grade 1–2 complications statistically correlated with readmission (P = .046). Four patients needed reoperation (2 patients in early “for appendicitis and adhesive small bowel obstruction” and 2 in late “for ureteroenteric stricture” readmission); meanwhile, 6 patients needed percutaneous procedures (4 patients in early “1 for anastomotic leak and 3 for pelvic collections” and 2 “for pelvic collections and ureterocutaneous fistula” in late readmission). CONCLUSION The rate of readmission within 90 days after RARC is significant. Female gender and body mass index are independent predictors of readmission. Outcomes at 90 days provide more thorough results, essential to proper patient counseling.

Systematic Review and Cumulative Analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Cystectomy

“…Most of the surgical series were retrospective, single-center studies, with the exception of some prospective studies [8,9,29,32,33,48,62,63,67,69,71,73,77] and some multi-institutional collaboration papers [19,24,26,30,38,39,43,45,72] (LOE 4). Only three of the comparative studies were randomized [78][79][80] (LOE 2b); all other comparative studies were nonrandomized, whether prospective or retrospective (LOE 4).…”

“…Specifically, with regard to series reporting on RARC with mainly extracorporeal conduit diversion, three studies reported on predictors of complications [28,39,43] and one reported on predictors of readmission [48]. …”

Preoperative nutritional factors and outcomes after radical cystectomy: A narrative review

“…BMI was not a predictor of mortality and complication development after RC in the Maurer et al 35 study, except for postoperative bleeding, which was more frequent in subjects with a high BMI. Compared to subjects with a BMI of 18-25kg/m 2 , subjects with a BMI >30kg/m 2 had a higher risk of cancer-specific mortality 38,42 , incisional hernia 40 , re-admission 30d and 90d after RC 39 , ileus 36 , parastomal hernia 45 and deep venous thrombosis 43,44 .…”

“…Twelve studies investigated the association between BMI and RC outcomes [33][34][35][36][37][38][39][40][41][42][43][44] . Reyes et al 33 found that tract infections, pyelonephritis, wound infections and overall complications were less frequent in normal-weight patients (18.5-24.9kg/m 2 ) compared to overweight (25-29.9kg/m 2 ) and obese (≥30.0kg/m 2 ) patients.…”

Assessment of healthcare quality metrics: length-of-stay, 30-day readmission, and 30-day mortality for radical nephrectomy with inferior vena cava thrombectomy

“…Previous studies of radical cystectomies and outpatient urological surgeries found certain patient-level characteristics, including sex and comorbidity, as predictors of readmission. [3][4][5] In 2% to 7% of patients with renal cell carcinoma (RCC), a tumour thrombus may develop that extends into the renal vein and inferior vena cava (IVC). 6,7 In these patients, thrombectomy is routinely performed in conjunction with radical nephrectomy.…”