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

Abstract

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. 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. 31,147 patients were identified and stratified by 30-day readmission (n\u2009=\u20092628) or no readmission (n\u2009=\u200928,519). 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\u2009<\u20090.001). The 90-day mortality rate was 7.2% overall (7.0% no readmission vs 9.9% 30-day readmission, p\u2009<\u20090.001). 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\u2009≥\u20092 (HR 1.88–7.09, all p\u2009<\u20090.001) as independent predictors of 90-day mortality. 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.