A Multipronged Intervention to Reduce Readmissions and Readmission Intensity After Radical Cystectomy
November 5, 2023
New research from the UPMC Department of Urology and the University of Pittsburgh's Urology Health Services Research Division assesses practices that may help reduce readmissions and readmission intensity after a patient undergoes a radical cystectomy.
Published online ahead of print in the journal Urology, results showed that implementing an evidence-based protocol decreased the intensity of readmission for patients.
The research team included Shan Wu; Michael Raver; Robin Vasan; Jennifer Mihalo; John Myrga, MD; David Miller, MD; Maria Pere, MD; Cameron Jones, MD; Danielle Sharbaugh, MPH; Jonathan Yabes, PhD; Bruce Jacobs, MD, MPH; and Benjamin Davies, MD, all of UPMC and Pitt, as well as Zeynep Gul, MD, from Washington University School of Medicine.
Study Overview
Objective: The goal of this study was to develop a multipronged, evidence-based protocol to reduce readmission risk and readmission intensity, as represented by the duration of the index readmission, after radical cystectomy.
Methods: A per-protocol study was performed. The protocol included preoperative nutritional supplementation, early stent removal, and a follow-up phone call within 4-5 days of discharge. The preprotocol period was from February 1, 2020, to July 31, 2021, and the postprotocol period was from December 1, 2020, to November 31, 2021. Using multivariate regression models, we compared outcomes among patients treated with radical cystectomy before and after protocol initiation.
Results: The team identified 70 preprotocol patients and 126 postprotocol patients. After adjusting for age, sex, BMI, and frailty score, results showed that there was a significant reduction in 90-day readmission intensity (7 vs 5 days; P = .048) among postprotocol patients.
Conclusion: Ultimately, after implementation of an evidence-based protocol for patients undergoing radical 90-day readmission, intensity decreased significantly. This protocol may move the needle forward on reducing readmissions, but a larger randomized trial is needed.
View the full study here.
Reference
Gul ZG, Wu S, Raver M, et al. A Multipronged Intervention to Reduce Readmissions and Readmission Intensity After Radical Cystectomy [published online ahead of print, 2023 Sep 4]. Urology. 2023;S0090-4295(23)00732-X. doi:10.1016/j.urology.2023.08.012
