scholarly journals Few modifiable factors predict readmission following radical cystectomy

2015 ◽  
Vol 9 (7-8) ◽  
pp. 439 ◽  
Author(s):  
Brian J Minnillo ◽  
Matthew J. Maurice ◽  
Nicholas Schiltz ◽  
Aiswarya C. Pillai ◽  
Siran M. Koroukian ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Care Facility ◽  
Hospital Performance ◽  
Home Healthcare ◽  
Related Factors ◽  
Factors Associated ◽  
Discharge Disposition ◽  
Modifiable Factors ◽  
High Readmission Rate

Introduction: We sought to determine the patient and providerrelated factors associated with readmission after radical cystectomy (RC) for bladder cancer. In this era of healthcare reform, hospital performance measures, such as readmission, are beginning to affect provider reimbursement. Given its high readmission rate, RC could be a target for quality improvement.Methods: We reviewed bladder cancer patients who underwent RC in California’s State Inpatient Database (2005–2009) of the Healthcare Cost and Utilization Project. We examined patient- (e.g., race, discharge disposition) and provider-related factors (e.g., volume) and evaluated their association with 30-day readmission. Multivariable logistic regression was used to examine associations of interest.Results: Overall, 22.8% (n = 833) of the 3649 patients who underwent RC were readmitted within 30 days. Regarding disposition, 34.8%, 50.8%, and 12.2% were discharged home, home with home healthcare, and to a post-acute care facility (PACF), respectively. Within 30 days, 20.3%, 20.9%, and 42.3% discharged home, home with home healthcare, and to a PACF were readmitted, respectively. African Americans (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.07–2.50), having ≥2 comorbidities (OR 1.42, 95% CI 1.06–1.91), receiving a neobladder (OR 1.45, 95% CI 1.09–1.93), and discharge to a PACF (OR 3.79, 95% CI 2.88–4.98) were independent factors associated with readmission. Hospital stays ≥15 days were associated with less readmission (OR 0.43, 95% CI 0.27–0.67, p = 0.0002). Procedure volume was not associated with complication, in-hospital mortality, or readmission.Conclusions: About one-fifth of patients undergoing RC are readmitted. Patients who are discharged to a PACF, African American, and who have more extensive comorbidities tend to experience more readmissions. Increased efforts with care coordination among these patients may help reduce readmissions.

scholarly journals Modifiable Factors Associated with Non-adherence to Antihypertensive or Antihyperlipidemic Drugs Are Dissimilar: a Multicenter Study Among Patients with Diabetes in Indonesia

2020 ◽  
Vol 35 (10) ◽  
pp. 2897-2906
Author(s):  
Sofa D. Alfian ◽  
Nurul Annisa ◽  
Fajriansyah Fajriansyah ◽  
Dyah A. Perwitasari ◽  
Rizky Abdulah ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Antihypertensive Drugs ◽  
Multinomial Logistic Regression ◽  
Cross Sectional Survey ◽  
Related Factors ◽  
Patient Counselling ◽  
Medication Beliefs ◽  
Factors Associated ◽  
Modifiable Factors

Abstract Background To develop targeted and tailored interventions for addressing medication non-adherence, it is important to identify underlying factors. Objective To identify factors associated with non-adherence as well as subtypes of non-adherence to antihypertensive or antihyperlipidemic drugs among patients with type 2 diabetes in Indonesia. Design An observational multicenter cross-sectional survey. Participants Patients with type 2 diabetes using either antihypertensive or antihyperlipidemic drugs in four regions in Indonesia. Main Measures Non-adherence and its subtypes of intentional and unintentional non-adherence were assessed using the Medication Adherence Report Scale. Necessity and concern beliefs were assessed with the Beliefs about Medicines Questionnaire. We applied binary and multinomial logistic regression to assess associations of medication beliefs, sociodemographic factors, and clinical-related factors to non-adherence and report odds ratios (OR) with 95% confidence intervals (CI). Key Results Of 571 participating patients (response rate 97%), 45.5% and 52.7% were non-adherent to antihypertensive and antihyperlipidemic drugs, respectively. Older age was associated with non-adherence to antihypertensive drugs (60–69 years) (OR, 5.65; 95% CI, 2.68–11.92), while higher necessity beliefs (OR, 0.92; 95% CI, 0.88–0.95) were associated with less non-adherence. Factors associated with non-adherence to antihyperlipidemic drugs were female gender (OR, 1.84; 95% CI, 1.03–3.27) and higher concern beliefs (OR, 1.10; 95% CI, 1.03–1.18), while higher necessity beliefs (OR, 0.89; 95% CI, 0.83–0.96) were associated with less non-adherence. Conclusions The main factors associated with non-adherence to antihypertensive and antihyperlipidemic drugs are modifiable. In general, beliefs about the necessity of the drug are important but for antihyperlipidemic drugs concerns are important as well. Healthcare providers should pay attention to identify and address medication beliefs during patient counselling.

scholarly journals Patient-Related Factors Associated With Hospital Discharge to a Care Facility After Critical Illness

2011 ◽  
Vol 20 (5) ◽  
pp. 378-386 ◽  
Author(s):  
B. K. Gehlbach ◽  
V. R. Salamanca ◽  
J. E. Levitt ◽  
G. A. Sachs ◽  
M. K. Sweeney ◽  
...  
Keyword(s):  
Critical Illness ◽  
Hospital Discharge ◽  
Care Facility ◽  
Related Factors ◽  
Factors Associated

scholarly journals Cost of Care in Open Cystectomy Patients Across Time and Space: Does it matter?

2021 ◽  
pp. 1-9
Author(s):  
Helen H. Sun ◽  
Megan Prunty ◽  
Ilaha Isali ◽  
Amr Mahran ◽  
Kevin Ginsburg ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Radical Cystectomy ◽  
Ileal Conduit ◽  
Cost Of Care ◽  
Teaching Hospitals ◽  
Factors Associated ◽  
Open Radical Cystectomy ◽  
Inpatient Complication

BACKGROUND: Many variables may affect the cost of open radical cystectomy (RC) care, including surgical approach, diversion type, patient comorbidities, and postoperative complications. OBJECTIVE: To determine factors associated with changes in cost of care following open radical cystectomy (ORC) for bladder cancer using the National Inpatient Sample (NIS). METHODS: Patients in the NIS with a diagnosis of bladder cancer who underwent ORC with ileal conduit from 2012–2017 using ICD-9-CM and ICD-10-CM codes were identified. Baseline demographics including age, race, region, postoperative complications, and length of stay were obtained. Univariable and multivariable logistic regression were used to identify factors associated with cost variation including demographics, clinical characteristics, surgical factors, and discharge quarter (Q1-Q4). RESULTS: 5,189 patients were included in the analysis, with 4,379 at urban teaching hospitals. On multivariable regression analysis, female sex [$1,734 ($1,024–2,444) p <  0.001)], a greater Elixhauser comorbidity score [$93 ($62–124), p <  0.001], presence of any inpatient complication [$1,531 ($894–2,168), p <  0.001], and greater length of stay [$1,665 ($1,536–1,793), p <  0.001] were associated with a greater cost of hospitalization. Discharge in Q3 (July to September) relative to Q2 (April to June) was associated with a higher cost [$1,113 ($292–1,933), p = 0.008. Trends were similar at urban non-teaching and rural hospitals, except discharge quarter was not associated with a significant change in cost. CONCLUSIONS: Significant differences in cost of ORC with ileal conduit exist with respect to patient sex, medical comorbidities, and discharge timing. These differences may relate to greater disease burden in female patients, patient complexity, and variation in postoperative care in academic programs.

scholarly journals P0570THE INCIDENCE, RISK FACTORS OF ACUTE KIDNEY DISEASES AND DISORDERS AND ITS IMPACT ON CHRONIC KIDNEY DISEASE IN PATIENTS AFTER RADICAL CYSTECTOMY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shengnan Ge ◽  
Ying Tang ◽  
Junzhe Chen ◽  
Wenjuan Yu ◽  
Anping Xu
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Bladder Cancer ◽  
Kidney Disease ◽  
Radical Cystectomy ◽  
Kidney Diseases ◽  
Operation Time ◽  
Factors Associated ◽  
Kaplan Meier ◽  
Incidence Risk

Abstract Background and Aims Acute kidney injury (AKI) is a widely-discussed complication associated with the radical cystectomy which is the gold standard for the management of invasive bladder cancer. Until now, few studies investigate the new criteria named Acute Kidney Diseases and Disorders(AKD) as the complication of radical cystectomy. In this study, we evaluated the incidence, risk factors of AKD and evaluate its impact on chronic kidney disease (CKD) in patients after radical cystectomy. Method A total of 279 patients who underwent radical cystectomy at Sun Yat-sen Memorial Hospital, Guangzhou, China, from January 2006 to June 2019 were evaluated, including 168 patients for Robotic-assisted Laparoscopic Radical Cystectomy (RLRC) and 111 patients for Laparoscopic Radical Cystectomy(LRC). AKD was diagnosed according to the classification scheme proposed in the 2012 KDIGO guideline. Logistic regression modeling was used to explore risk factors of AKD, while risk factors associated with CKD in AKD patients were investigated using Kaplan-Meier analysis, respectively. Results The overall incidence of AKD after radical cystectomy was 34.1% (95 out of 279) ,the incidences differ significantly between the RLRC and LRC groups (67 [39.9%] vs 28 [25.2%], P=0.011). Among 279 patients, risk factors associated with postoperative AKD included RLRC (OR 2.067, 95%CI 1.188 to 3.595, P=0.010), Age (years) (OR 1.046, 95%CI 1.018 to 1.074, P=0.001), baseline eGFR&lt;60(ml/(min.1.73m2) (OR 2.662, 95%CI 1.355 to 5.230, P=0.004), Further subgroup analysis identified age, operation time&lt;250(min) as important risk factors of AKD in RLRC patients but not in LRC patients. Of 211 patients with a preoperative estimated glomerular filtration rate (eGFR) of &gt; 60 ml/min/1.73 m2, CKD developed in 16.0% (21/ 131) of patients in the non-AKD group and 36.3% (29/ 80) of patients in the AKD group. Kaplan-Meier analysis(shown in figure 1) identified that AKD is associated with higher CKD rates in those patients (P &lt;0.001). Conclusion One-third of bladder cancer patients developed AKD after after radical cystectomy. RLRC, Age, baseline eGFR &lt;60(ml/(min.1.73m2) were independent risk factors for postoperative AKD in all patients. Occurance of AKD could increase the risk of new-onset CKD in the long run. Though the use of RLRC is now well established, we should be aware that it may increase the risk of postoperative AKD, especially for patients who are old and with lower eGFR .Besides, we should try to improve the management of those AKD patients with aim toward preventing further development of CKD.

scholarly journals Predictors of Nonroutine Discharge Among Patients Undergoing Surgery for Grade I Spondylolisthesis: Insights From the Quality Outcomes Database (QOD)

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Praveen V Mummaneni ◽  
Mohamad Bydon ◽  
John Knightly ◽  
Mohammed Ali Alvi ◽  
Anshit Goyal ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Degenerative Spondylolisthesis ◽  
Care Facility ◽  
Quality Outcomes ◽  
Acute Care Facility ◽  
Factors Associated ◽  
Discharge Disposition ◽  
Patient Reported ◽  
The Impact

Abstract INTRODUCTION Discharge to an in-patient rehabilitation facility or another acute care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to health-care costs. In the era of changing dynamics of healthcare payment models where the risk of cost over-runs are being increasingly shifted to surgeons and hospitals, it is important to understand better outcomes such as discharge disposition. In the current manuscript, we sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis. METHODS We queried the Quality Outcomes Database for patients with grade 1 lumbar degenerative spondylolisthesis undergoing a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multiside study investigating the impact of fusion on clinical and Patient Reported Outcomes (PROs) among patients with grade 1 spondylolisthesis were evaluated. Nonroutine discharge was defined as those that were discharged to postacute or nonacute care setting in the same hospital or transferred to another acute care facility. RESULTS Of the 605 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to an inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute care facility). On multivariable logistic regression, after adjusting for an array of demographic, socioeconomic, clinical, and operative variables, factors found to be independently associated with higher odds of nonroutine discharge included higher age (OR 10.53, 95% CI 3.8-29.2, P < .001), higher BMI (OR 2.42, 95% CI 1.45-4.05, P < .001), depression (OR 4.97, 95% CI 2.10-11.77, P < .001), and length of stay (OR 3.4, 95% CI 2.3-4.9, P < .001). CONCLUSION In this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included higher age, higher BMI, presence of depression, and higher length of stay.

scholarly journals Long-term renal function and mortality after radical cystectomy and ileal conduit formation.

2020 ◽  
Author(s):  
Julio Chevarria ◽  
Chaudhry A. Ebad ◽  
Mairead Hamill ◽  
Catalin Constandache ◽  
Cliona Cowhig ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Renal Function ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Beaumont Hospital ◽  
Renal Function Decline ◽  
Factors Associated ◽  
Renal Function Deterioration

Abstract Background. Treatment for bladder cancer includes radical cystectomy (RC) and urinary diversion, RC is associated with long-term morbidity, renal function deterioration and mortality. Our aim was to identify risk factors associated with postoperative long-term renal function decline and mortality. Methods. Retrospective study in patients with RC and urinary diversion in Beaumont Hospital from 1996 to 2016. We include patients who had assessment for at least two years post procedure and confirmed live status. We assessed the estimated glomerular filtration rate (eGFR) preoperatively, at first and second year, renal function decline > 10 ml/min/1.73 m2, start dialysis and mortality. Logistic regression analyses were applied to assess risk factors associated, a significant p-value < 0.05 was considered. Results. We included 264 patients, with median age 68.3 years, 73,7% males, main diagnose was bladder cancer 93.3%, TNM stages were grouped in T ≥ 2 75.9%, N ≥ 1 47.6% and M1 28%. The median eGFR preoperative was 65.8 ml/min/1.73 m2 and after 2 years 58.2 ml/min/1.73 m2 (p:0.009), 5.6% required chronic dialysis and 32.8% had a decrease > 10 ml/min/1.73 m2. Risk factors associated with ESKD included age (HR:1.13, CI95% 1.05–1.22), preoperative eGFR (HR:1.04, CI95% 1.01–1.07). Overall mortality was 43.2%, 75.9% at 5 and 10 years respectively, risk factors were age (HR:1.1, CI95% 1.04–1.18), preoperative eGFR (HR:1.03, CI95% 1.01–1.06) and male gender (HR:14.8, CI95% 1.1–192). Conclusions. Patients with RC have risk of progressive renal function deterioration and high mortality and the main risk factors associated were age, sex, and preoperative eGFR. Regular monitoring of renal function will permit early diagnosis and treatment.

scholarly journals Impact of timing of adjuvant chemotherapy following radical cystectomy for bladder cancer on patient survival.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16017-e16017
Author(s):  
Camilla Marisa Grunewald ◽  
Alina Henn ◽  
Matt D. Galsky ◽  
Elizabeth R. Plimack ◽  
Lauren Christine Harshman ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Radical Cystectomy ◽  
Statistical Significance ◽  
Patient Characteristics ◽  
Tumor Characteristics ◽  
Related Factors ◽  
Cox Regression Analysis ◽  
The Impact

e16017 Background: Trials of adjuvant chemotherapy following radical cystectomy generally require chemotherapy to start approximately 90 days postoperatively. However, it is unclear, whether the interval between surgery and start of adjuvant therapy (S-AC-interval) impacts the oncological outcome. Methods: Using the Retrospective International Study of Invasive/Advanced Cancer of the Urothelium (RISC) data base, we identified patients who underwent radical cystectomy for muscle invasive bladder cancer and subsequent adjuvant chemotherapy. Uni- and multi-variate analysis of patient characteristics, surgical factors and tumor characteristics regarding their impact on S-AC-interval was performed. Uni- and multivariate analysis of progression-free and overall survival (starting from day 1 of adjuvant chemotherapy) was analysed in relation to SAC interval (both continuous and dichotomous with a cut-off at 90 days), patient characteristics, surgical factors and tumor characteristics by Kaplan-Meier and COX regression analysis. Results: Two hundred thirty-eight eligible patients were identified (83% male, median age: 64 years, 76% T3/T4, 66% pN+, 15% R+, 75% urothelial carcinoma, 71% cisplatin-based adjuvant chemotherapy). Median S-AC-interval was 57 days (range 10-321 days, ≤ 90 days: 87%, 91-120 days: 6%, > 120 days: 7%). S-AC-interval did not have association with any patient/tumor characteristics or surgery related factors (type of surgery, diversion). S-AC-interval did not impact patients´ outcomes when adjuvant chemotherapy was initiated 90 days after surgery. Median PFS and OS in patients with an S-AC-interval of 90 days was 37 and 73 months, respectively, as compared to 24 and 48 months in patients with an S-AC-interval > 90 days. Only differences in PFS reached statistical significance (37 (95% CI 26-48) months vs. 24 (95% CI 12-36) months p = .042; Log Rank test). When analyzed by different multivariate models, the impact of S-AC-interval on PFS and OS was negated by tumor related factors (pathological T-stage and N-stage). Conclusions: An S-AC-interval of below 90 days is likely to be optimal in bladder cancer patients requiring adjuvant therapy. However, regarding prognosis, tumor related pathological factors seem to be more important than the S-AC-interval.

Sign in / Sign up

Export Citation Format

Share Document