PURPOSE: The Patient Protection and Affordable Care Act increases oversight of surgical outcomes and ties readmissions to Medicare reimbursement.
Given the increasing volume of outpatient urological procedures, this study provides the first multi-institutional, multivariate analysis of the patient factors that contribute to readmission.
MATERIALS AND METHODS: Using the National Surgical Quality Improvement Program database from 2011, 7,795 patients were isolated. Multiple logistic regression was utilized to predict 30 day unplanned readmissions controlling for demographics, clinical characteristics and comorbidities. The readmission rates for the 5 most common procedures were calculated along with postoperative complications associated with readmission.
RESULTS: Outpatient urological surgery had an overall 3.7% readmission rate. The five most common procedures and their readmission rates were cystourethroscopy and resection of bladder tumor (4.97%), laser prostatectomy (4.27%), TURP (4.24%), excision of hydrocele (1.92%) and sling operation for urinary incontinence (0.85%). The most common comorbidities in the readmitted patients included hypertension, diabetes and smoking. Risk adjusted multiple regression indicated that cancer history (OR 3.48), bleeding disorder (OR 2.03), male gender (OR 1.38), ASA level 3 or 4 (OR 1.34) and age (OR 1.01) were significant predictors for readmission. Readmitted patients also had higher rates of 30-day complications.
CONCLUSION: Readmission after outpatient urological surgery occurs at a rate of 3.7%. A history of cancer, bleeding disorder, male gender, ASA level 3 or 4 and age were associated with readmission along with greater rates of medical and surgical complications. Our results may help guide risk reduction initiatives and prevent costly readmissions.
Written by:
Rambachan A, Matulewicz R, Pilecki M, Kim JY, Kundu SD. Are you the author?
Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Reference: J Urol. 2014 Feb 8. pii: S0022-5347(14)00053-6.
doi: 10.1016/j.juro.2013.12.053
PubMed Abstract
PMID: 24518788
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