San Diego, CA USA (UroToday.com) John A. Brockman, MD. discussed he and his colleagues study assessing the impact of a cystectomy care pathway on readmission rates. Patients undergoing cystectomy have a prolonged length of stay, as well as high risk of readmission. A recovery pathway that began graduated implementation in March 2014 was developed at the authors institute.
The protocol included pre-operative epidural and heparin administration with a 28 day course of enoxaparin. Alvimopan, a mu opioid antagonist, early enteral feeding and no nasogastric tube were used for early return of bowel function. A clean closure protocol was also used. The authors sought to determine whether this protocol had an effect on the type of readmissions that occurred after hospital discharge.
Data on 118 patients undergoing cystectomy after initiation of the care pathway between March 2014 and June 2015 was prospectively collected. This data was compared with chart collected data of the last 118 patient operated on prior to the pathway initiation. Eligible patients were those undergoing radical cystectomy with any diversion at their institution.
Univariate tests were performed using Wilcoxon sum-rank tests for quantitative variables and chi-square tests of independence for qualitative variables. Multivariate analyses were performed using logistic regression models to assess for patient factors related to readmissions. Length of stay decreased from 10 days to 6.8 days (p<0.001) with implementation of the bundle. 30 days readmission rate did not significantly change (31.5% vs 34.2%, p= 0.668). However, the reason for readmissions did.
Wound and deep space infections dropped from 41.2% to 22.5% of readmissions (p=0.08). This was balanced by an increase in readmissions for UTI (14.7% vs 35% p=0.046). Multivariate analysis showed no significant risk factors for readmission. The authors conclude that the implementation of a cystectomy care pathway significantly decreases length of stay without an increased rate of readmissions at 30 days. No patient factors predisposed to an increased rate of readmission. Pathway implementation led to a decrease in wound and deep space infection readmissions, but was associated with an increase in UTI readmissions.
Presented By: John A. Brockman, MD
Written By: Miki Haifler MD. Fox Chase Cancer Center, Philadelphia, PA. at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA