Thirty day readmissions and outcomes following radical nephrectomy in renal cell carcinoma: A nationwide analysis.

Authors

Trilok Shrivastava

Trilok Shrivastava

John H. Stroger, Jr. Hospital of Cook County, Chicago, IL

Trilok Shrivastava , Miguel Salazar , Victor Prado , Estefania Gauto , Binav Baral , Shristi Upadhyay , Maha A.T. Elsebaie

Organizations

John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, Cleveland Clinic, Cleveland, OH, University of Cincinnati Department of Internal Medicine, Cincinnati, OH, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, John H. Stroger Jr. Hospital of Cook County, Cleveland, IL

Research Funding

No funding received
None

Background: Nephrectomy is one of the primary treatments of Stage I-III renal cell carcinoma (RCC), which is usually associated with low rates of serious morbidity and mortality. However, a fraction of patients gets readmitted after the surgery for numerous reasons which can impact their overall prognosis. Methods: We conducted a retrospective cohort study using the 2017 National Readmission Database of adult patients with RCC readmitted within 30 days after an index admission for nephrectomy. We aimed to identify the 30-day readmission rate, mortality, resource utilization, and independent predictors of readmission. Results: A total of 25,307 patients with RCC underwent nephrectomy. The 30-day readmission rate was 8.7%. The top five causes for readmission were sepsis, AKI, STEMI, surgical infections & metastatic disease. Patients requiring readmission were less likely to be discharged home (56.5 vs 81.8%), have private insurance (27.2 vs 34.7), obesity (14.7 vs 20.6%), hypertension (30.9 vs 47.1%), and be admitted to a teaching hospital (75.8 vs 79.2%). They were more likely to be insured with Medicare (58.3 vs 53.3%), have lower income (28.7 vs 26.3%), type 2 diabetes (32.4 vs 26.7%), CKD (44.1 vs 20.7%), malnutrition (9.2 vs 2.1%), undergo chemotherapy (5.2 vs 1.9%). Readmission was associated with higher in-hospital mortality (1.5 vs. 0.1%), CVA (0.6 vs 0.3%), AKI (29.6 vs 16.9%) and pleural effusion (7.8 vs 1.8%). They were also more likely to require mechanical ventilation (3.5 vs 1.8%), parenteral nutrition (1.2 vs 0.4%) and hemodialysis (11.9 vs 4.5%). The in-hospital economic burden of readmission was $128 million in total charges and $31.8 million in total costs. Independent predictors of readmission were disposition to a short-term hospital or skilled nursing facility, length of stay, need for mechanical ventilation and transfusion of blood products, having type 1 diabetes, malnutrition, pleural effusion, and CKD. Younger age and private insurance were associated with preventing readmission. Conclusions: Readmissions after nephrectomy in patients with RCC are associated with increased in-hospital mortality rate and pose a high health care economic burden. We identified few risk factors and patient characteristics associated with post-surgical readmissions; however, further in-depth studies are needed to find preventable risk factors.

Variable
aOR (95% CI)
P-value
Female (Mean 37.1)
0.95 (0.82-1.10)
0.53
Age (Mean 63.3)
0.98 (0.97-0.99)
< 0.01
Disposition

Skilled nursing facility

Home health Care

Against medical advice


1.90 (1.49-2.43)

1.59 (1.32-1.91)

3.34 (1.11-10.02)


< 0.01

< 0.01

0.03
Insurance Provider

Private


0.72 (0.61-0.85)


< 0.01
Comorbidities

CKD


1.29 (1.08-1.54)


< 0.01
In-Hospital Complications

Shock

Mechanical ventilation

Pleural effusion


1.08 (1.01-1.02)

1.52 (1.07-2.15)

1.50 (1.05-2.13)


< 0.01

< 0.01

0.02
Length of stay (days)
1.01 (1.01-1.02)
< 0.01

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Genitourinary Cancer—Kidney and Bladder

Track

Genitourinary Cancer—Kidney and Bladder

Sub Track

Kidney Cancer

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr e16560)

DOI

10.1200/JCO.2021.39.15_suppl.e16560

Abstract #

e16560

Abstract Disclosures

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