Introduction & Objectives: Radical cystectomy (RC) is the gold-standard treatment for muscle-invasive and BCG-resistant bladder cancer. Despite improvements in complication rate and length of hospital stay (LOS), this complex surgery maintains a high readmission rate leading to increased patient morbidity and medical costs. Several studies on this topic have been performed in the US, but representative European research is limited. To contribute in understanding and preventing readmissions after RC, we analyzed the 30-day post-discharge readmission rate and its related risk factors at our institution.
Materials & methods: We conducted a retrospective consecutive analysis on 96 RC patients with bladder cancer treated between 2015-2018 at our institution. All patients were treated according to our institutional perioperative protocol for RC, an ERAS protocol that includes culture based antibiotic prophylaxis during ureteral stent removal.
Results: Our cohort consisted of mostly male patients (71.9%) with a median age of 68 and median ASA-score of 2, the median LOS was 12.5 days. 30-day readmission rate was 14.1%, significantly lower than most US series. Causes of readmission were primarily infections, mainly UTI/urosepsis, and secondly gastro-intestinal complications. Only in 2 out of 13 readmitted patients (15.4%) a major Clavien-Dindo score was applicable (Table 1). Multivariate analysis showed that LOS ≥13 days and lymph node invasion significantly associate with a higher hazard ratio of 30-day readmission.
Conclusions: Supporting recent literature, we believe that infection prevention plays a crucial role in reducing readmission after RC. Our contemporary series analysis showed a low readmission rate in RC patients, suggesting that culture based antibiotic prophylaxis during stent removal is sufficient and effective and stressing the importance of a clear regimen on this subject in both European and American guidelines. Strict follow-up in fragile patients and patients with LOS ≥13 days, could possibly prevent readmission after radical cystectomy.
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Table 1. Causes of 30-day readmission in 13 patients after RC for bladder cancer.
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Cause
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Clavien-Dindo score
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Total amount
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Minor (≤2)
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Major (≥3)
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Infectious
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4
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2
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6 (46.15)
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Gastro-intestinal
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3
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0
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3 (23.07)
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Wound
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1
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0
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1 (7.69)
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Pulmonary
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1
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0
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1 (7.69)
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Neurologic
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1
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0
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1 (7.69)
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Oncologic
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-*
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-*
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1 (7.69)
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Data are presented as n (%).
*Concerns palliative care, no Clavien-Dindo score was assigned
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