Risk factors for infectious readmissions following radical cystectomy: Results from a prospective multicenter dataset

Sij Hemal, Louis S. Krane, Kyle A. Richards, Michael A Liss, A. Karim Kader, Ronald L. Davis

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder cancer. This procedure has a high rate of perioperative complications, many of which are infectious in nature. The objective of our study was to evaluate demographic, intrinsic and extrinsic patient variables associated with developing readmission within 30 days due to infectious complications following RC. Methods: We acquired data available from the American College of Surgeons National Surgical Quality Improvement Program. We queried this dataset to identify all patients who underwent RC for muscle-invasive malignant disease (CPT 188.x) in 2012 based on CPT coding. Logistic regression analysis was used to investigate the relationship between preoperative variables and readmissions for infectious complications. Results: Of the 961 patients undergoing cystectomy for malignancy, 159 (17%) required readmission for any indications at a median of 16 days (interquartile range 13-22 days) postoperatively. We identified 71 of a total of 159 (45%) readmissions, which were due to infectious complications. Smoking was more prevalent in the patient population readmitted for an infectious complication compared with the patient population readmitted for a non-infectious complication (37% versus 25%; p = 0.03). Using logistic regression analysis smoking was associated with a significant risk for readmission due to an infectious cause (odds ratio 2.28, 95% confidence interval 1.82-2.97, p = 0.02). Readmission due to an infectious etiology was not associated with other perioperative factors including type of urinary diversion, sex, duration of operation, hypertension, or recent weight loss. Conclusion: Readmission following RC is a common occurrence and infectious complications drive readmission in almost half of the cases. Current smoking was the only independent risk factor for an infectious readmission. Counseling patients in smoking cessation prior to the procedure may provide an avenue for quality improvement to limit readmissions.

Original languageEnglish (US)
Pages (from-to)167-174
Number of pages8
JournalTherapeutic Advances in Urology
Volume8
Issue number3
DOIs
StatePublished - Jan 1 2016

Fingerprint

Cystectomy
Smoking
Quality Improvement
Logistic Models
Regression Analysis
Muscles
Urinary Diversion
Smoking Cessation
Urinary Bladder Neoplasms
Population
Datasets
Counseling
Weight Loss
Odds Ratio
Demography
Confidence Intervals
Hypertension
Neoplasms

Keywords

  • bladder cancer
  • complications
  • cystectomy
  • National Surgical Quality Improvement Program
  • smoking

ASJC Scopus subject areas

  • Urology

Cite this

Risk factors for infectious readmissions following radical cystectomy : Results from a prospective multicenter dataset. / Hemal, Sij; Krane, Louis S.; Richards, Kyle A.; Liss, Michael A; Kader, A. Karim; Davis, Ronald L.

In: Therapeutic Advances in Urology, Vol. 8, No. 3, 01.01.2016, p. 167-174.

Research output: Contribution to journalArticle

Hemal, Sij ; Krane, Louis S. ; Richards, Kyle A. ; Liss, Michael A ; Kader, A. Karim ; Davis, Ronald L. / Risk factors for infectious readmissions following radical cystectomy : Results from a prospective multicenter dataset. In: Therapeutic Advances in Urology. 2016 ; Vol. 8, No. 3. pp. 167-174.
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abstract = "Introduction: Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder cancer. This procedure has a high rate of perioperative complications, many of which are infectious in nature. The objective of our study was to evaluate demographic, intrinsic and extrinsic patient variables associated with developing readmission within 30 days due to infectious complications following RC. Methods: We acquired data available from the American College of Surgeons National Surgical Quality Improvement Program. We queried this dataset to identify all patients who underwent RC for muscle-invasive malignant disease (CPT 188.x) in 2012 based on CPT coding. Logistic regression analysis was used to investigate the relationship between preoperative variables and readmissions for infectious complications. Results: Of the 961 patients undergoing cystectomy for malignancy, 159 (17{\%}) required readmission for any indications at a median of 16 days (interquartile range 13-22 days) postoperatively. We identified 71 of a total of 159 (45{\%}) readmissions, which were due to infectious complications. Smoking was more prevalent in the patient population readmitted for an infectious complication compared with the patient population readmitted for a non-infectious complication (37{\%} versus 25{\%}; p = 0.03). Using logistic regression analysis smoking was associated with a significant risk for readmission due to an infectious cause (odds ratio 2.28, 95{\%} confidence interval 1.82-2.97, p = 0.02). Readmission due to an infectious etiology was not associated with other perioperative factors including type of urinary diversion, sex, duration of operation, hypertension, or recent weight loss. Conclusion: Readmission following RC is a common occurrence and infectious complications drive readmission in almost half of the cases. Current smoking was the only independent risk factor for an infectious readmission. Counseling patients in smoking cessation prior to the procedure may provide an avenue for quality improvement to limit readmissions.",
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