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Charlson comorbidity score is associated with readmission to the index operative hospital after radical cystectomy and correlates with 90-day mortality risk

  • Urology - Original Paper
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Abstract

Purpose

Our objective was to determine perioperative variables associated with 30-day readmission to the index operative hospital after radical cystectomy for bladder cancer and subsequent survival outcomes.

Methods

Retrospective cohort study utilizing the United States National Cancer Database from 2004–2015. All clinical stages undergoing radical cystectomy were analyzed. Exclusion criteria included clinical suspicion of nodal disease, metastasis, or preoperative radiation therapy. Multivariable logistic regression was used for 30-day readmission risk to the index hospital. Kaplan–Meier analysis and multivariable Cox regressions were used for survival outcomes.

Results

31,147 patients were identified and stratified by 30-day readmission (n = 2628) or no readmission (n = 28,519). Thirty-day readmission to the index surgery hospital was 8.4%. Groups were comparable in terms of age, gender, race, income, facility type, insurance, length of hospital stay, and pathologic stage. There were significantly more patients with higher Charlson comorbidity score in the readmission cohort. On logistic regression analysis, increasing Charlson score was the only predictor of 30-day readmission (OR 1.39–1.73, p < 0.001). The 90-day mortality rate was 7.2% overall (7.0% no readmission vs 9.9% 30-day readmission, p < 0.001). Cox regression analysis for mortality revealed increasing age (HR 1.04), higher Charlson score (HR 1.42–1.85), readmission within 30 days (HR 1.38) and pathologic stage pT ≥ 2 (HR 1.88–7.09, all p < 0.001) as independent predictors of 90-day mortality.

Conclusions

Increasing comorbidity is a strong predictor of readmission to the index surgery hospital after radical cystectomy. Readmission is associated with worsened mortality at 90 days.

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Acknowledgements

The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed or the conclusions drawn from these data by the investigator.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA

    Coleman McFerrin, Syed Johar Raza, Allison May, Facundo Davaro, Sameer Siddiqui & Zachary Hamilton

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  1. Coleman McFerrin
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  2. Syed Johar Raza
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  3. Allison May
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  4. Facundo Davaro
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  5. Sameer Siddiqui
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  6. Zachary Hamilton
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Corresponding author

Correspondence to Zachary Hamilton.

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All listed authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent is not required due to the retrospective de-identified dataset from a national tumor registry.

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McFerrin, C., Raza, S.J., May, A. et al. Charlson comorbidity score is associated with readmission to the index operative hospital after radical cystectomy and correlates with 90-day mortality risk. Int Urol Nephrol 51, 1755–1762 (2019). https://doi.org/10.1007/s11255-019-02247-6

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  • DOI: https://doi.org/10.1007/s11255-019-02247-6

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