Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Present Address: Department of Urology, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205.
Biostatistics and Bioinformatics Shared Resource, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
Urol Oncol. 2022 Apr;40(4):164.e1-164.e7. doi: 10.1016/j.urolonc.2021.09.001. Epub 2021 Oct 8.
To assess predictors, indicators and medical necessity of readmissions after neoadjuvant chemotherapy and radical cystectomy in order to identify opportunities for reducing readmission rates.
Records for patients treated with cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy between 2007 and 2017 were reviewed for 90-day complications and readmission. Readmissions were classified as necessary vs. discretionary based on independent clinician review. The association between postoperative complications and necessary or discretionary readmission were examined with adjusted regression models.
Among a total of 250 patients, 76 patients (30.4%) were readmitted within 90 days of surgery (19 discretionary and 57 necessary). Age, insurance coverage, and comorbidity were similar between readmitted and non-readmitted patients. Readmission was more likely after neobladder than ileal conduit (39% vs. 23%, P = 0.02). Major (grade ≥ 3) complications within 90-day of surgery including index admission and post-discharge period were significantly more common among re-admitted patients compared to patients who were not readmitted (40% in necessary, 21% in discretionary, 3% in none, P < 0.001). Median length of stay on readmission was twice as long in necessary cases compared to discretionary cases (5 vs. 2.5 days, P < 0.001). Gastrointestinal and infectious complications were associated with discretionary readmission in adjusted analyses, while infectious, renal/genitourinary and thromboembolic complications were associated with necessary readmission.
Twenty-five percent of readmissions were categorized as discretionary and were driven primarily by low-grade gastrointestinal complications, marginal oral intake and failure to thrive, suggesting that better coordinated post-discharge supportive care could help avoid a substantial proportion of readmissions.
评估新辅助化疗和根治性膀胱切除术后再入院的预测因素、指标和医疗必要性，以确定降低再入院率的机会。
对 2007 年至 2017 年间接受顺铂为基础的新辅助化疗后行根治性膀胱切除术的患者的记录进行了 90 天并发症和再入院的回顾性分析。根据独立临床医生的评估，将再入院分为必要和非必要。使用调整后的回归模型检查术后并发症与必要或非必要再入院之间的关系。
在总共 250 名患者中，76 名（30.4%）在手术后 90 天内再次入院（19 例非必要，57 例必要）。再入院患者和未再入院患者的年龄、保险覆盖范围和合并症相似。与回肠导管相比，行新膀胱术的患者再入院的可能性更高（39% vs. 23%，P=0.02）。与未再入院的患者相比，在 90 天内再次入院的患者在索引入院和出院后期间发生的主要（3 级及以上）并发症更为常见（必要病例 40%，非必要病例 21%，无病例 3%，P<0.001）。必要病例的再入院中位住院时间是非必要病例的两倍（5 天 vs. 2.5 天，P<0.001）。在调整分析中，胃肠道和感染并发症与非必要再入院相关，而感染、肾/泌尿生殖系统和血栓栓塞并发症与必要再入院相关。
25%的再入院被归类为非必要，主要由低级别胃肠道并发症、经口摄入不足和生长不良驱动，这表明更好的出院后支持性护理协调可以帮助避免大量的再入院。
