Editorials
Reducing Readmissions and Mortality after Radical Cystectomy READMISSION as a quality and cost containment metric is now a major issue for hospitals, clinicians and policy makers.1 The initial mandate focused on myocardial infarction, heart failure and pneumonia,2 but this year the Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program will expand its focus on readmissions to include surgical patients undergoing elective hip and knee replacements. The data regarding hospital readmissions are compelling. One in 5 elderly patients is readmitted to the hospital within 30 days of discharge. Avoidable readmissions cost Medicare $15 billion per year. Hospital readmissions more than double the cost of providing care to an individual patient. Konety and Allareddy reported that 1 postoperative complication after radical cystectomy (RC) nearly doubled the odds of mortality, and increased median total charges and length of stay by $15,000 and 4 days, respectively (median total charges with no complications $41,905).3 The postoperative complications with the most significant impact were those directly related to surgery (primary complications). While the controversy continues regarding penalizing hospitals for high readmission rates, there is little doubt that this metric is here to stay. In this issue of The Journal Skolarus et al (page 1500) analyze hospital readmissions after radical cystectomy to better understand why some readmissions are more resource intensive than others (readmission intensity).4 The SEER (Surveillance, Epidemiology, and End Results)-Medicare database was used to identify patients who underwent RC between 2003 and 2009. A total of 1,782 patients met the study criteria, and readmission length of stay was used to categorize hospital readmission intensity into quartiles of less than 3 days (lowest intensity), 3 to 4 days, 5 to 7 days and more than 7 days (highest intensity). Overall 1 in 4 patients (25.5%) who underwent RC was readmitted within 30 days of discharge. Readmission intensity did not differ according to age, gender, ethnicity, socioeconomic status, pathological stage, comorbidity, urinary diversion type or administration of neoadjuvant chemotherapy. Differences
0022-5347/15/1935-1461/0 THE JOURNAL OF UROLOGY® © 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
in readmission intensity were observed based on variables related to the index admission for RC. Patients who were discharged to a skilled nursing facility (p
Reducing Readmissions and Mortality after Radical Cystectomy READMISSION as a quality and cost containment metric is now a major issue for hospitals, clinicians and policy makers.1 The initial mandate focused on myocardial infarction, heart failure and pneumonia,2 but this year the Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program will expand its focus on readmissions to include surgical patients undergoing elective hip and knee replacements. The data regarding hospital readmissions are compelling. One in 5 elderly patients is readmitted to the hospital within 30 days of discharge. Avoidable readmissions cost Medicare $15 billion per year. Hospital readmissions more than double the cost of providing care to an individual patient. Konety and Allareddy reported that 1 postoperative complication after radical cystectomy (RC) nearly doubled the odds of mortality, and increased median total charges and length of stay by $15,000 and 4 days, respectively (median total charges with no complications $41,905).3 The postoperative complications with the most significant impact were those directly related to surgery (primary complications). While the controversy continues regarding penalizing hospitals for high readmission rates, there is little doubt that this metric is here to stay. In this issue of The Journal Skolarus et al (page 1500) analyze hospital readmissions after radical cystectomy to better understand why some readmissions are more resource intensive than others (readmission intensity).4 The SEER (Surveillance, Epidemiology, and End Results)-Medicare database was used to identify patients who underwent RC between 2003 and 2009. A total of 1,782 patients met the study criteria, and readmission length of stay was used to categorize hospital readmission intensity into quartiles of less than 3 days (lowest intensity), 3 to 4 days, 5 to 7 days and more than 7 days (highest intensity). Overall 1 in 4 patients (25.5%) who underwent RC was readmitted within 30 days of discharge. Readmission intensity did not differ according to age, gender, ethnicity, socioeconomic status, pathological stage, comorbidity, urinary diversion type or administration of neoadjuvant chemotherapy. Differences
0022-5347/15/1935-1461/0 THE JOURNAL OF UROLOGY® © 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
in readmission intensity were observed based on variables related to the index admission for RC. Patients who were discharged to a skilled nursing facility (p
