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Early discharge and post‐discharge outcomes in patients undergoing radical cystectomy for bladder cancer
Author(s) -
Xia Leilei,
Taylor Benjamin L.,
Newton Andrew D.,
Malhotra Aseem,
Pulido Jose E.,
Strother Marshall C.,
Guzzo Thomas J.
Publication year - 2018
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14058
Subject(s) - medicine , cystectomy , confidence interval , odds ratio , logistic regression , bladder cancer , complication , subgroup analysis , hospital discharge , surgery , cancer
Objective To assess whether discharging patients early after radical cystectomy (RC) is associated with an increased risk of readmission and post‐discharge complications. Materials and Methods The National Surgical Quality Improvement Program database was queried to identify patients who underwent an elective RC from 2012 to 2015. Patients were stratified into two groups: those with a length of hospital stay (LOS) of 4–5 days (early‐discharge group) and those with an LOS of 6–9 days (routine‐discharge group). We used multivariable logistic regression analyses to assess the impact of early discharge on 30‐day readmission and post‐discharge complication rates. Sensitivity analyses and subgroup analyses were performed to validate the robustness of our primary analyses. Results A total of 3 311 patients were included. Unadjusted outcomes comparison showed no difference in readmission rate (21.6% vs 23.0%) or post‐discharge complication rate (17.7% vs 19.6%) between the early‐discharge and the routine‐discharge group. Multivariable logistic regression also showed that early discharge was not associated with increased odds of readmission (odds ratio [OR] 1.00, 95% confidence interval [CI] 0.82–1.22; P = 1.000) or post‐discharge complications (OR 0.95, 95% CI 0.77–1.17; P = 0.616). Two‐step sensitivity analyses (excluding patients with LOS of 8–9 days, followed by patients with any pre‐discharge adverse event) validated the robustness of our primary analyses. Subgroup analyses also yielded similar results in all subgroups except for the subgroup of patients aged ≥85 years. Conclusions Early discharge after RC was not associated with increased readmissions or post‐discharge complications. Future prospective studies, with defined peri‐operative care pathways, are needed to identify potential components that may enable hospitals to discharge patients early without compromising post‐discharge outcomes.