Introduction:

Over the last decade, in an effort to decrease the morbidity associated with radical cystectomy (RC) and to improve patient outcomes, Enhanced Recovery After Surgery (ERAS) protocols have been developed and implemented following RC. The effect of ERAS protocols on readmission rates following RC is not well understood. There are no recent studies since the widespread implementation of ERAS protocols that provide nationally representative estimates of readmission rates following RC using a database that captures non-index readmissions. The goal of this study, was to provide nationally representative estimates of contemporary trends in readmission rates, readmission location (index vs. non-index hospital), and causes of readmission following radical cystectomy (RC) in the era of enhanced recovery after surgery (ERAS) protocol implementation.

Methods:

Patients diagnosed with bladder cancer who underwent RC were identified in the Nationwide Readmissions Database (2016-2019). Yearly trends in 30-day and 90-day readmission rates and readmission causes were assessed in the whole cohort and subset of patients who underwent RC at high volume centers (>22 RCs/year). Multivariable logistic regression was used to determine predictors of index readmission, non-index readmission, death during readmission, and experiencing a second readmission.

Results:

Among the 20,957 RC patients, the 30-day and 90-day readmission rates were 23.5% (n=4931) and 39.1% (n=7987), respectively. For 90-day readmissions, 27.6% (n=2206) were to non-index hospitals. During the study period, there was no significant change in the yearly 30-day or 90-day readmission rates and percentage of readmissions to non-index hospitals (all p>0.05, Figure 1). This was also true in the subset of patients who underwent RC at high volume centers (Figure 1). The only significant change in causes of readmission during the study period was wound readmissions (2.7% in 2016 vs. 5.1% of readmissions in 2019, p=0.02).

Conclusion:

During the era of ERAS protocol implementation, in this nationally representative study, most causes of readmission and both 30 and 90-day readmission rates were unchanged, even at high volume RC centers. Moving forward, novel interventions are needed which focus on the post-discharge recovery period to help decrease readmission rates following RC.

Funding: N/A