MP32-07 THE DRIVING FORCES AND COST OF READMISSIONS AND DEATHS IN POST-OPERATIVE RADICAL CYSTECTOMY PATIENTS AT 30 DAY AND 90 DAY READMISSIONS (2015)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness IV1 Apr 2015MP32-07 THE DRIVING FORCES AND COST OF READMISSIONS AND DEATHS IN POST-OPERATIVE RADICAL CYSTECTOMY PATIENTS AT 30 DAY AND 90 DAY READMISSIONS Danny Lascano, Jamie S. Pak, Daniel Kabat, LaMont J. Barlow, G. Joel DeCastro, William Gold, and James M. McKiernan Danny LascanoDanny Lascano More articles by this author , Jamie S. PakJamie S. Pak More articles by this author , Daniel KabatDaniel Kabat More articles by this author , LaMont J. BarlowLaMont J. Barlow More articles by this author , G. Joel DeCastroG. Joel DeCastro More articles by this author , William GoldWilliam Gold More articles by this author , and James M. McKiernanJames M. McKiernan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1403AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy (RC) is one of the most morbid surgeries given its complexity and the demographic of patients who need it most: an elderly population with many pre-existing comorbidities. Causes of deaths and readmissions in a 30-day and 30 to 90-day interval have not been examined. This study looks at the drivers of readmissions and death at the top 20 medical centers as ranked by the amount of radical cystectomies performed in New York State. METHODS Using the Statewide Planning and Research Cooperative System (SPARC), an established New York State wide database that aggregates data across all hospitals in the state, data was collected per hospital in aggregated, de-identified fashion in 20 hospitals performing RC in New York State from 2009 to 2011. ICD-9 codes were looked at longitudinally and for individual patients with the cause of admission being attributed to the main diagnosis code on admission. Preventable complications include DVTs/PE, chronic disease exacerbations, post-operative pain, UTIs, and IV associated catheter infections. RESULTS For the 1940 cases, 506 readmissions occurred during the first 30 days after RC at a rate of 0.26 readmissions per patient with 22% (426/1940) patients necessitating readmission. For 31-90 days post-surgery, 315 readmissions occurred at a rate of 0.16 per patient with only 4.1% (80/1940 patients) requiring readmission. There were 8 patient deaths within 30 days of surgery and 3 additional patient deaths between post-op days 31 and 90 for a total of 11 deaths of the 506 patients admitted after surgery. The predictors of readmissions on multivariate analysis at 30 days were sepsis, UTIs and preventable complications as defined above (p < 0.001 for all). The drivers of death on 30 days were a main diagnosis of infection, DVT, pneumonias, and complications from pre-existing conditions (p < 0.01 for all). The sum of the mean hospital charges for 0-30 days was $25,847,275.00 ($51,081 per re-admission) and from 31-90 days it was $1,073,019.00 ($50,364 per re-admission). CONCLUSIONS Emphasis on post-operative management to avoid preventable complications and prophylaxis for DVT and PE may help decrease readmissions and death rates after RC. These measures may also reduce the cost of radical cystectomy readmissions, which currently represent a significant burden on the health care system. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e366-e367 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Danny Lascano More articles by this author Jamie S. Pak More articles by this author Daniel Kabat More articles by this author LaMont J. Barlow More articles by this author G. Joel DeCastro More articles by this author William Gold More articles by this author James M. McKiernan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...