The Fate of Radical Cystectomy Patients after Hospital Discharge: Understanding the Black Box of the Pre-readmission Interval

Abstract Background Radical cystectomy has one of the highest 30-d hospital readmission rates but circumstances leading to readmission remain poorly understood. Objective To examine the postdischarge period and better understand hospital readmission after radical cystectomy. Design, setting, and participants We conducted a retrospective cohort study of patients treated with radical cystectomy for bladder cancer from 2005 to 2012 using our institutional database. Outcome measurements and statistical analysis We assessed patient communication with any healthcare system after hospital discharge based on timing, methods, and concern types. Logistic regression and Cox proportional-hazards analyses were used to compare postdischarge concerns among readmitted and nonreadmitted patients. We internally validated the logistic model using a bootstrap resampling technique. Results and limitations One-hundred patients (23%) were readmitted within 30 d of index discharge. Readmitted patients were more likely to use the emergency department with initial concerns compared with nonreadmitted patients (27% vs 1.0%, p Conclusions Radical cystectomy patients who contact the health system soon after discharge or communicated infectious or failure to thrive symptoms (fever, poor oral intake, or vomiting) are more likely to experience readmission as opposed to those that endorse pain, constipation, or ostomy issues. Better understanding of this pre-readmission interval can optimize postdischarge practices. Patient summary We looked at bladder cancer patients who had surgery and the reasons why they were readmitted to hospital. We found patients who had a fever or difficulty with eating and maintaining their weight had the highest chance of being readmitted.