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SUO 2017

SUO 2017: Hospital Readmissions after Radical Cystectomy: The Impact of an Enhanced Recovery Pathway

Washington, DC (UroToday.com) Dr. Khanna and colleagues from the Cleveland Clinic presented their research assessing hospital readmissions after radical cystectomy, with a specific focus on the implementation of an enhanced recovery pathway. Because radical cystectomy is associated with greater morbidity and health service utilization than any other surgical procedure in urology, enhanced recovery pathways have been instituted [1], demonstrating decreased length of stay. Despite this, it has been suggested that earlier discharge may lead to increased readmission rates. The objective of this study was to assess return to hospital outcomes following implementation of a peri-operative optimization pathway for patients undergoing radical cystectomy at a high-volume tertiary care center.

There were 98 patients who underwent radical cystectomy that were enrolled in a post-operative enhanced recovery pathway from October 2016 – March 2017. Outcomes for the first six months of patients enrolled in this pathway were compared to a cohort of patients undergoing radical cystectomy in the nine months immediately prior to pathway initiation (n=112). Categorical and continuous variables were compared between groups using chi-square and t-test, respectively. There were no baseline differences between the two groups with regards to age, gender, BMI, operative blood loss, diabetes, COPD, hypertension, or smoking. Median length of stay decreased from 7 days to 5 days following implementation of the protocol (p<0.001). The proportion of patients with any unplanned return to the hospital after discharge decreased from 50.9% before protocol implementation to 30.6% after implementation (p=0.003). There was a 40% reduction in post-discharge emergency room visits (p=0.16), 31.3% reduction in observation stays (p=0.34), and 25.4% reduction in 30-day readmissions (p=0.32) following protocol implementation. Furthermore, the majority of hospital readmissions occurred in the first 11 days irrespective of study group. 

In summary, implementation of an enhanced recovery pathway for radical cystectomy patients reduced length of stay as well as unplanned returns to the hospital. This study should help to alleviate early discharge post-radical cystectomy concerns for increased readmission rates and continue to encourage implementation of enhanced recovery pathways. 


References:

1. Cerantola Y, Valerio M, Persson B, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS) society recommendations. Clin Nutr 2013;32(6):879-887.


Presented by: Abhinav Khanna, MD, MPH

Co-Authors: Anna Zampini MD MBA, Kyle Ericson MD, Michele Fascelli MD, Prithvi Murthy MD, Alice Crane MD PhD, Byron Lee MD PhD and Georges Pascal Haber MD PhD

Affiliation: Cleveland Clinic

Written by: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC