2015 Joint Annual Meeting
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Can We Prevent Unplanned Readmissions following Transurethral Resection of Bladder Tumors? An Analysis of a Large Single Institutionís Experience
Fady Ghali1, Rachel A Moses2, Eric Raffin2, Elias S Hyams2
1Geisel School of Medicine at Dartmouth, Hanover, NH;2Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH

Introduction:
There is growing scrutiny of unplanned readmissions (UR) as a cost and quality concern in urological care. Transurethral resection of bladder tumor (TURBT) is a high volume ambulatory surgery that is the largest source of readmission among urological procedures. We sought to evaluate factors associated with UR following TURBT.
Materials and Methods:
A retrospective review of TURBTs performed at a single academic institution between April 2011 and August 2014 was performed. Demographics, comorbidities, outpatient vs. same-day surgery, tumor size, procedure duration, Foley placement, adjuvant mitomycin, length of stay(LOS), anticoagulation, prior biopsy history, referring hospital service area, and insurance type were recorded. Bivariate analysis and multivariate regression analysis were conducted to determine factors associated with unplanned 30-day readmission.
Results:
Among 708 patients undergoing TURBT, 23.9% were female with an average age of 70 yrs. Unplanned 30-day readmission rate was 4.7%. Bivariate analysis revealed higher rates of UR with Foley placement, non-aspirin anticoagulation, and LOS>1day; preoperative oral antibiotics, aspirin therapy, and prior TURBT were associated with lower risk(p1 day were associated with higher risk, while preoperative antibiotics and aspirin therapy were associated with lower risk of UR (p<0.05).
Conclusions:
Patients at increased risk for UR (e.g. those requiring foley placement or prolonged recovery) may benefit from more vigilant postoperative follow-up. Interestingly, further distance from the hospital and larger tumor size were not independently associated with UR. Preventing UR is essential to improve the quality and cost effectiveness of urological care moving forward.


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