Title

30-day all-cause hospital readmission after cystectomy: no worse for rural Medicare residents.

Document Type

Article

Publication Date

3-1-2018

Publication Title

Urologic oncology

Abstract

OBJECTIVE: To evaluate rural/urban disparities in 30-day all-cause hospital admission after cystectomy.

MATERIALS AND METHODS: We used the SEER-Medicare database to identify all Medicare beneficiaries who underwent radical cystectomy (ICD-9 codes 57.7, 57.71, 57.79, and 68.8) between the years 1991 and 2009, yielding a total sample size of 15,572. Our primary outcome was 30-day hospital readmission rate. Rural Urban Continuum Codes were used to designate county-level rural status based on patient residence. Location of surgery was not a variable considered in this analysis. A multivariable regression model was constructed with demographic and clinical variables as covariates.

RESULTS: A total of 2,003 rural and 2,904 urban patients (31.1% vs. 31.8%, P = 0.33) were readmitted within 30 days of discharge. In the multivariable model, older age, unmarried status, lower socioeconomic status, higher Charlson comorbidity score, shorter index admission hospital stay, and discharge to a skilled nursing facility were associated with higher odds of readmission. The variables for gender, race, cancer stage, tumor grade, and type of urinary diversion were not significant. The odds ratio for readmission was not significant for patients from rural counties in the final model.

CONCLUSIONS: Rural Medicare residents were not at higher risk for 30-day all-cause hospital readmission after cystectomy after accounting for various demographic and clinical variables.

Medical Subject Headings

Age Factors; Aged; Aged, 80 and over; Comorbidity; Cystectomy; Female; Healthcare Disparities; Humans; Male; Medicare; Patient Readmission; Postoperative Complications; Rural Health Services; Social Class; Time Factors; United States; Urban Health Services; Urinary Bladder Neoplasms

PubMed ID

29249273

Volume

36

Issue

3

First Page

7

Last Page

89

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