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Predictors of Readmission following Outpatient Urological Surgery

2014; Lippincott Williams & Wilkins; Volume: 192; Issue: 1 Linguagem: Inglês

10.1016/j.juro.2013.12.053

1527-3792

Aksharananda Rambachan, Richard S. Matulewicz, Matthew Pilecki, John Y. S. Kim, Shilajit Kundu,

Hospital Admissions and Outcomes

No AccessJournal of UrologyAdult Urology1 Jul 2014Predictors of Readmission following Outpatient Urological Surgery Aksharananda Rambachan, Richard S. Matulewicz, Matthew Pilecki, John Y.S. Kim, and Shilajit D. Kundu Aksharananda RambachanAksharananda Rambachan , Richard S. MatulewiczRichard S. Matulewicz , Matthew PileckiMatthew Pilecki , John Y.S. KimJohn Y.S. Kim , and Shilajit D. KunduShilajit D. Kundu View All Author Informationhttps://doi.org/10.1016/j.juro.2013.12.053AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The Patient Protection and Affordable Care Act increases oversight of surgical outcomes and ties hospital readmissions to Medicare reimbursement. Given the increasing volume of outpatient urological procedures, to our knowledge this study provides the first multi-institutional multivariate analysis of patient factors that contribute to readmission. Materials and Methods: Using the 2011 National Surgical Quality Improvement Program database we identified 7,795 patients. Multiple logistic regression was used to predict 30-day unplanned hospital readmissions controlling for demographics, clinical characteristics and comorbidities. Readmission rates of the 5 most common procedures were calculated along with the rate of postoperative complications associated with readmission. Results: Outpatient urological surgery had an overall 3.7% readmission rate. The 5 most common procedures were cystourethroscopy and resection of bladder tumor (readmission rate 4.97%), laser prostatectomy (4.27%), transurethral resection of prostate (4.24%), hydrocele excision (1.92%) and sling surgery for urinary incontinence (0.85%). The most common comorbidities in readmitted patients were hypertension, diabetes and smoking. Risk adjusted multiple regression indicated that cancer history (OR 3.48), bleeding disorder (OR 2.03), male gender (OR 1.38), ASA® level 3 or 4 (OR 1.34) and age (OR 1.01) were significant predictors of readmission. Readmitted patients also had a higher 30-day complication rate. Conclusions: Readmission after outpatient urological surgery occurs at a rate of 3.7%. A history of cancer, bleeding disorder, male gender, ASA level 3 or 4 and age were associated with readmission along with greater rates of medical and surgical complications. Our results may help guide risk reduction initiatives and prevent costly readmissions. References 1 : Cost of readmission: can the Veterans Health Administration (VHA) experience inform national payment policy?. Med Care2013; 51: 13. Google Scholar 2 : Health care reform and cost control. N Engl J Med2010; 363: 601. Google Scholar 3 Sahni N, Cutler D and Kocher R: HealthAffairs Blog. Will the Readmission Rate Penalties Drive Hospital Behavior Changes? Available at http://healthaffairs.org/blog/2013/02/14/will-the-readmission-rate-penalties-drive-hospital-behavior-changes/. Accessed July 22, 2013. Google Scholar 4 : Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ2011; 183: E391. Google Scholar 5 Centers for Medicare & Medicaid Services: Readmission Reduction Program. Available at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Accessed July 22, 2013. Google Scholar 6 : CAUTI and readmission penalties: urologists beware. Can J Urol2013; 20: 6592. Google Scholar 7 : Medicare payments for outpatient urological surgery by location of care. Urologic Diseases in America Project. J Urol2012; 188: 2323. Link, Google Scholar 8 : Ambulatory surgery in the United States, 2006. Natl Health Stat Report2009; 11: 1. Google Scholar 9 : Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs. J Clin Anesth2002; 14: 349. Google Scholar 10 : What happens after discharge? Return hospital visits after ambulatory surgery. Anaesth Analg1997; 84: 319. Google Scholar 11 : Is day surgery safe? A Danish multicentre study of morbidity after 57,709 day surgery procedures. Acta Anaesthesiol Scand2012; 56: 323. Google Scholar 12 : Day surgery in Finland: a prospective cohort study of 14 day-surgery units. Acta Anaesthesiol Scand2009; 53: 455. Google Scholar 13 : Readmissions in the postoperative period following urinary diversion. World J Urol2011; 29: 79. Google Scholar 14 : Unplanned urology readmission in a district general hospital: are we meeting the standard?. J Clin Urol2013; 6: 289. Google Scholar 15 : Adverse events and readmissions after day-case urological surgery. Int Braz J Urol2007; 33: 330. Google Scholar 16 User Guide for the 2011 Participant Use Data File. American College of Surgeons, National Surgical Quality Improvement Program. October 2012. Available at http://site.acsnsqip.org/wp-content/uploads/2012/03/2011-User-Guide_Final.pdf. Accessed August 1, 2013. Google Scholar 17 : Blueprint for a new American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg2008; 207: 777. Google Scholar 18 : Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg2010; 210: 6. Google Scholar 19 : Validation of new readmission data in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg2013; 216: 420. Google Scholar 20 : Design and statistical methodology of the National Surgical Quality Improvement Program: why is it what it is?. Am J Surg2009; 198: S19. Google Scholar 21 : Applied Logistic Regression, 2nd ed. Hoboken: Wiley-Interscience2000. Google Scholar 22 Singer EA and Palapattu GS: Complications of transurethral resection of bladder tumors. In: Complications of Urologic Surgery: Prevention and Management, 4th ed. Edited by SS Taneja. Philadelphia: Saunders 2009; chapt 25, pp 295–302. Google Scholar 23 : Differences in 30-day preventable readmission rates after index cancer surgery in New York State hospitals. J Clin Oncol2013; 31. abstract 6640. Google Scholar 24 : Factors associated with adverse outcome following urologic surgery in patients aged 80 years and older. Aging Clin Exp Res2013; 25: 75. Google Scholar 25 : Risk adjustment for evaluating the outcome of urological operative procedures. J Urol2001; 166: 968. Link, Google Scholar 26 : Risk prediction models for hospital readmission: a systematic review. JAMA2011; 306: 1688. Google Scholar 27 : Posthospital care transitions: patterns, complications and risk identification. Health Serv Res2004; 39: 1449. Google Scholar 28 : Post-hospital syndrome—an acquired, transient condition of generalized risk. N Eng J Med2013; 368: 100. Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChevli K, Shore N, Trainer A, Smith A, Saltzstein D, Ehrlich Y, Raman J, Friedman B, D'Anna R, Morris D, Hu B, Tyson M, Sankin A, Kates M, Linehan J, Scherr D, Kester S, Verni M, Chamie K, Karsh L, Cinman A, Meads A, Lahiri S, Malinowski M, Gabai N, Raju S, Schoenberg M, Seltzer E and Huang W (2021) Primary Chemoablation of Low-Grade Intermediate-Risk Nonmuscle-Invasive Bladder Cancer Using UGN-102, a Mitomycin-Containing Reverse Thermal Gel (Optima II): A Phase 2b, Open-Label, Single-Arm TrialJournal of Urology, VOL. 207, NO. 1, (61-69), Online publication date: 1-Jan-2022.Patel N, Golan R, Halpern J, Sun T, Asafu-Adjei A, Chughtai B, Stahl P, Sedrakyan A and Kashanian J (2018) A Contemporary Analysis of Dual Inflatable Penile Prosthesis and Artificial Urinary Sphincter OutcomesJournal of Urology, VOL. 201, NO. 1, (141-146), Online publication date: 1-Jan-2019.Carlos E, Peters C, Wollin D, Winship B, Davis L, Li J, Scales C, Eaton S, Preminger G and Lipkin M (2018) Psychiatric Diagnoses and Other Factors Associated with Emergency Department Return within 30 Days of UreteroscopyJournal of Urology, VOL. 201, NO. 3, (556-562), Online publication date: 1-Mar-2019.Caveney M, Brooks D, Haddad D, Kovell R and Terlecki R (2017) NSQIP® Indexed Complications Following Transurethral Bladder Tumor Resection and Contemporary Financial ImplicationsUrology Practice, VOL. 5, NO. 5, (391-397), Online publication date: 1-Sep-2018.Moses R, Ghali F, Pais V and Hyams E (2015) Unplanned Hospital Return for Infection following Ureteroscopy—Can We Identify Modifiable Risk Factors?Journal of Urology, VOL. 195, NO. 4 Part 1, (931-936), Online publication date: 1-Apr-2016.Bloom J, Matthews G and Phillips J (2015) Factors Influencing Readmission after Elective UreteroscopyJournal of Urology, VOL. 195, NO. 5, (1487-1491), Online publication date: 1-May-2016.Steers W (2014) This Month in Adult UrologyJournal of Urology, VOL. 192, NO. 1, (1-2), Online publication date: 1-Jul-2014.Master V (2014) Leaning in to Understand Hospital ReadmissionJournal of Urology, VOL. 192, NO. 1, (10-12), Online publication date: 1-Jul-2014. Volume 192Issue 1July 2014Page: 183-188Supplementary Materials Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordsurinary bladdersurgical proceduresPatient Protection and Affordable Care Actpatient readmissionoperativeprostateMetricsAuthor Information Aksharananda Rambachan More articles by this author Richard S. Matulewicz More articles by this author Matthew Pilecki More articles by this author John Y.S. Kim More articles by this author Shilajit D. Kundu More articles by this author Expand All Advertisement PDF downloadLoading ...