3 years ago

Early Discharge and Post-Discharge Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer

Thomas J. Guzzo, Jose E. Pulido, Andrew D. Newton, Marshall C. Strother, Aseem Malhotra, Benjamin L. Taylor, Leilei Xia
Objective To assess whether discharging patients early after radical cystectomy (RC) is associated with increased risk of readmissions and post-discharge complications. Materials and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried to identify patients who underwent an elective RC from 2012 to 2015. Patients were stratified into two groups: those with hospital length of stay (LOS) of 4-5 days (early-discharge) and those with LOS of 6-9 days (routine-discharge). We used multivariable logistic regressions to assess the impact of early-discharge on 30-day readmission and post-discharge complication rates. Sensitivity analyses and subgroup analyses were performed to validate the robustness of our primary analyses. Results A total of 3,311 patients were included. Unadjusted outcomes comparison showed no difference in readmission rate (21.6% vs. 23.0%) or post-discharge complication rate (17.7% vs. 19.6%) between early-discharge and routine-discharge groups. Multivariable logistic regression also showed early discharge was not associated with increased odds of readmission (OR=1.00, 95%CI=0.82-1.22, P=1.000) or post-discharge complication (OR=0.95, 95%CI=0.77-1.17, P=0.616). Two-step sensitivity analyses (excluding patients with LOS of 8-9 days followed by patients with any pre-discharge adverse event) validated the robustness of our primary analyses. Subgroup analyses also showed similar results in all subgroups except the subgroup of patients with age ≥ 85 years. Conclusions Early discharge after RC was not associated with readmissions or post-discharge complications. Future prospective studies, with defined perioperative care pathways, are needed to identify potential components that may enable hospitals to discharge patients early without compromising post-discharge outcomes. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/bju.14058

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