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

Autor: Krishnan N; University of Michigan Medical School, Ann Arbor, MI, USA., Li B; University of Michigan College of Literature, Science, and the Arts, Ann Arbor, MI, USA., Jacobs BL; Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA., Ambani SN; Department of Urology, University of Michigan, Ann Arbor, MI, USA., Borza T; Department of Urology, University of Michigan, Ann Arbor, MI, USA; Division of Oncology, University of Michigan, Ann Arbor, MI, USA; Dow Division of Health Services Research, University of Michigan, Ann Arbor, MI, USA., He C; Dow Division of Health Services Research, University of Michigan, Ann Arbor, MI, USA., Hollenbeck BK; Department of Urology, University of Michigan, Ann Arbor, MI, USA; Division of Oncology, University of Michigan, Ann Arbor, MI, USA; Dow Division of Health Services Research, University of Michigan, Ann Arbor, MI, USA., Morgan T; Department of Urology, University of Michigan, Ann Arbor, MI, USA; Division of Oncology, University of Michigan, Ann Arbor, MI, USA., Hafez KS; Department of Urology, University of Michigan, Ann Arbor, MI, USA; Division of Oncology, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA., Weizer AZ; Department of Urology, University of Michigan, Ann Arbor, MI, USA; Division of Oncology, University of Michigan, Ann Arbor, MI, USA., Montgomery JS; Department of Urology, University of Michigan, Ann Arbor, MI, USA; Division of Oncology, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA., Lee CT; Department of Urology, University of Michigan, Ann Arbor, MI, USA; Division of Oncology, University of Michigan, Ann Arbor, MI, USA., Lesse O; Department of Urology, University of Michigan, Ann Arbor, MI, USA., Lavieri MS; University of Michigan College of Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Industrial and Operations Engineering, Ann Arbor, MI, USA., Helm JE; Indiana University Kelley School of Business, Bloomington, IN, USA., Skolarus TA; Department of Urology, University of Michigan, Ann Arbor, MI, USA; Division of Oncology, University of Michigan, Ann Arbor, MI, USA; Dow Division of Health Services Research, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. Electronic address: tskolar@med.umich.edu.
Jazyk: angličtina
Zdroj: European urology focus [Eur Urol Focus] 2018 Sep; Vol. 4 (5), pp. 711-717. Date of Electronic Publication: 2016 Aug 04.
DOI: 10.1016/j.euf.2016.07.004
Abstrakt: 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<0.001). Patients who took longer to first communicate their concerns and who were able to tolerate their symptoms longer had lower odds of readmission. Patients who reported infection (adjusted hazard ratio: 2.8, 95% confidence interval: 1.4-5.8) and failure to thrive concerns (adjusted hazard ratio: 4.4, 95% confidence interval: 2.0-9.3) were more likely to be readmitted compared with those who communicated noninfectious wounds and/or urinary concerns.
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.
(Copyright © 2016 European Association of Urology. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: