Predictors of readmission following outpatient urological surgery

Aksharananda Rambachan, Richard S. Matulewicz, Matthew Pilecki, John Y S Kim, Shilajit D. Kundu*

*Corresponding author for this work

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Purpose The Patient Protection and Affordable Care Act increases oversight of surgical outcomes and ties hospital readmissions to Medicare reimbursement. Given the increasing volume of outpatient urological procedures, to our knowledge this study provides the first multi-institutional multivariate analysis of patient factors that contribute to readmission. Materials and Methods Using the 2011 National Surgical Quality Improvement Program database we identified 7,795 patients. Multiple logistic regression was used to predict 30-day unplanned hospital readmissions controlling for demographics, clinical characteristics and comorbidities. Readmission rates of the 5 most common procedures were calculated along with the rate of postoperative complications associated with readmission. Results Outpatient urological surgery had an overall 3.7% readmission rate. The 5 most common procedures were cystourethroscopy and resection of bladder tumor (readmission rate 4.97%), laser prostatectomy (4.27%), transurethral resection of prostate (4.24%), hydrocele excision (1.92%) and sling surgery for urinary incontinence (0.85%). The most common comorbidities in readmitted patients were 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 of readmission. Readmitted patients also had a higher 30-day complication rate. Conclusions 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.

Original languageEnglish (US)
Pages (from-to)183-188
Number of pages6
JournalJournal of Urology
Volume192
Issue number1
DOIs
StatePublished - Jan 1 2014

Fingerprint

Ambulatory Surgical Procedures
Patient Readmission
Comorbidity
Patient Protection and Affordable Care Act
Hemorrhage
Transurethral Resection of Prostate
Urinary Incontinence
Risk Reduction Behavior
Prostatectomy
Medicare
Quality Improvement
Urinary Bladder Neoplasms
Neoplasms
Lasers
Outpatients
Multivariate Analysis
Logistic Models
Smoking
Demography
Databases

Keywords

  • Patient Protection and Affordable Care Act
  • operative
  • patient readmission
  • prostate
  • surgical procedures
  • urinary bladder

ASJC Scopus subject areas

  • Urology

Cite this

Rambachan, Aksharananda ; Matulewicz, Richard S. ; Pilecki, Matthew ; Kim, John Y S ; Kundu, Shilajit D. / Predictors of readmission following outpatient urological surgery. In: Journal of Urology. 2014 ; Vol. 192, No. 1. pp. 183-188.
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abstract = "Purpose The Patient Protection and Affordable Care Act increases oversight of surgical outcomes and ties hospital readmissions to Medicare reimbursement. Given the increasing volume of outpatient urological procedures, to our knowledge this study provides the first multi-institutional multivariate analysis of patient factors that contribute to readmission. Materials and Methods Using the 2011 National Surgical Quality Improvement Program database we identified 7,795 patients. Multiple logistic regression was used to predict 30-day unplanned hospital readmissions controlling for demographics, clinical characteristics and comorbidities. Readmission rates of the 5 most common procedures were calculated along with the rate of postoperative complications associated with readmission. Results Outpatient urological surgery had an overall 3.7{\%} readmission rate. The 5 most common procedures were cystourethroscopy and resection of bladder tumor (readmission rate 4.97{\%}), laser prostatectomy (4.27{\%}), transurethral resection of prostate (4.24{\%}), hydrocele excision (1.92{\%}) and sling surgery for urinary incontinence (0.85{\%}). The most common comorbidities in readmitted patients were 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{\circledR} level 3 or 4 (OR 1.34) and age (OR 1.01) were significant predictors of readmission. Readmitted patients also had a higher 30-day complication rate. Conclusions 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.",
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Predictors of readmission following outpatient urological surgery. / Rambachan, Aksharananda; Matulewicz, Richard S.; Pilecki, Matthew; Kim, John Y S; Kundu, Shilajit D.

In: Journal of Urology, Vol. 192, No. 1, 01.01.2014, p. 183-188.

Research output: Contribution to journalArticle

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N2 - Purpose The Patient Protection and Affordable Care Act increases oversight of surgical outcomes and ties hospital readmissions to Medicare reimbursement. Given the increasing volume of outpatient urological procedures, to our knowledge this study provides the first multi-institutional multivariate analysis of patient factors that contribute to readmission. Materials and Methods Using the 2011 National Surgical Quality Improvement Program database we identified 7,795 patients. Multiple logistic regression was used to predict 30-day unplanned hospital readmissions controlling for demographics, clinical characteristics and comorbidities. Readmission rates of the 5 most common procedures were calculated along with the rate of postoperative complications associated with readmission. Results Outpatient urological surgery had an overall 3.7% readmission rate. The 5 most common procedures were cystourethroscopy and resection of bladder tumor (readmission rate 4.97%), laser prostatectomy (4.27%), transurethral resection of prostate (4.24%), hydrocele excision (1.92%) and sling surgery for urinary incontinence (0.85%). The most common comorbidities in readmitted patients were 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 of readmission. Readmitted patients also had a higher 30-day complication rate. Conclusions 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.

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