INCIDENCE AND PREDICTORS OF 30-DAY READMISSION IN PATIENTS
TREATED WITH ROBOT-ASSISTED RADICAL PROSTATECTOMY
Introduction. Although several studies reported advantages related to the adoption of
robot-assisted radical prostatectomy (RARP) in terms of postoperative pain, blood
transfusions, and length of hospital stay, evidence is scarce regarding the incidence
and predictors of readmission in these patients.
Methods. Overall, 1,402 prostate cancer (PCa) patients treated with RARP at a single
center between 2006 and 2013 were identified. Baseline comorbidities were
categorized according to the Charlson comorbidity Index (CCI). Postoperative
complications during the first hospitalization were both categorized using both the
Clavien-Dindo classification system and detailed as follows: bleeding/haematoma,
lymphorrhoea/lymphocoeles, fever, urinary fistula, cardiovascular event, and other.
Patients experiencing 30-day readmission were identified. Uni- and multivariate
logistic regression analyses tested the association between 30-day readmission and
age at surgery, the receipt of pelvic lymph node dissection, CCI, and the severity of
postoperative complications classified according to the Clavien-Dindo system as well
as the type of postoperative complications.
Results. Median patient age was 63 years. Overall, 161 (11.5%) patients experienced
a postoperative complication during the first hospitalization. The most frequent type
of
complication
was
bleeding/haematoma
(6.1%),
followed
by
lymphorrhoea/lymphocoeles (1.4%). Clavien- Dindo distribution during first
hospitalization was 0 in 1241 (88.5%), 1 in 53 (3.8%), 2 in 69 (4.9%) and ≥3 in 39
(2.8%) patients. Overall, 38 patients (2.7%) needed a new hospitalization within 30
days after discharge. The most common causes of re-hospitalization were fever in 12
patients (31.6%), lymphoceles in 11 (28.9%) and urinary leak in 6 (15.8%). The
proportion of patients who experienced 30-day readmission was significantly higher
among patients who had a complication during the first hospitalization compared to
those who did not experience a complication during the first hospitalization (6.2 vs.
2.3%, respectively; P=0.01). At multivariable analyses, the occurrence of a
complication during the first hospitalization and its severity represented independent
predictors of 30-day readmission, after accounting for confounders (all P<0.01).When
looking at the type of complication, fever (OR: 7.05; P=0.01), urinary fistula (OR:
13.41; P<0.01), and cardiocirculatory complications (OR: 19.05; P<0.001) were
significantly associated with 30-day readmission.
Conclusions. Our observations show that patients undergoing RARP have a relatively
low risk of 30-day readmission (2.7%). Of note, the occurrence of a postoperative
complication represented the only independent predictor of 30-day readmission. In
this context, fever, urinary fistula, and cardiovascular complications represent the type
of complications significantly associated with higher risk of readmission. Our
findings highlight the need for better patient management when a complication occurs
during hospitalization for RARP.