Laparoscopy and Robotics Incidence and Risk Factors for 30-Day Readmission in Patients Undergoing Nephrectomy Procedures: A Contemporary Analysis of 5276 Cases From the National Surgical Quality Improvement Program Database Riccardo Autorino, Homayoun Zargar, Sam Butler, Humberto Laydner, and Jihad H. Kaouk OBJECTIVE MATERIALS AND METHODS
RESULTS
CONCLUSION
R
To explore factors associated with readmission after nephrectomy procedures using a large national database. A national surgical outcomes database, the American College of SurgeoneNational Surgical Quality Improvement Program registry, was queried for data on all patients undergoing open partial nephrectomy (OPN), minimally invasive (laparoscopic þ robotic) partial nephrectomy (MIPN), and minimally invasive radical nephrectomy (MIRN) in 2011 and 2012. Patients undergoing these procedures were identified using the Current Procedural Terminology codes. The primary outcome was unplanned 30-day hospital readmission. A multivariate logistic regression model was constructed to assess for factors independently associated with the primary outcome. Overall, 5276 cases were identified and included in the analysis: 1411 OPN (26.7%), 2210 MIPN (41.8%), and 1655 MIRN (31.3%). Overall, the 30-day readmission rate was 5.9% (7.8% for OPN, 4.5% for MIPN, and 6.1% for MIRN). On multivariate analysis, the odds for 30-day readmission for MIPN was approximately 70% that of OPN (P ¼ .012). The odds for 30-day readmission for 2012 was about 80% of that of 2011 (P 10 and/or condition index >10) with the rest of the variables in the matrix were dropped from the list of variables used in the multivariate study. The remaining independent variables were analyzed using backward logistic regression methods. The final reduced model contained only those covariates exhibiting significant correlation (P < .05) with the outcome.
Outcomes
RESULTS
The primary outcome was unplanned hospital readmission within 30 days of the index surgical procedures. Readmissions included hospitalization to either the same or another hospital after the initial surgical procedure. Hospitalizations within 30 days of discharge that were planned at the time of surgery were not included. The ACS-NSQIP participant use readmission data file has been previously validated and shown to accurately capture unplanned readmission events.10 Preoperative variables collected by NSQIP include demographic data (age, gender, race, body mass index, smoking status, and steroid use) and baseline medical comorbidities (diabetes mellitus, dyspnea, chronic obstructive pulmonary disease, pneumonia, congestive heart failure, history of myocardial infarction, previous percutaneous coronary intervention, previous cardiac surgery, angina, peripheral vascular disease, hypertension, renal failure, dialysis, transient ischemic attack, cerebrovascular accident, bleeding disorder [any condition placing the patient at risk for excessive bleeding requiring hospitalization owing to a deficiency of blood clotting elements: vitamin K deficiency, hemophilia, thrombocytopenia, chronic anticoagulation therapy that has not been discontinued before surgery], preoperative transfusion, and American Society of Anesthesiology [ASA] class). For the purpose of the analysis, some variables were grouped by combining predefined NSQIP variables: dyspnea, chronic obstructive pulmonary
Overall, 5276 patients were identified and included in the analysis: 1411 OPN (26.7%), 2210 MIPN (41.8%), and 1655 MIRN (31.3%; Table 1). Patients in the MIRN group were older (63.0 12.9 years; P
RESULTS
CONCLUSION
R
To explore factors associated with readmission after nephrectomy procedures using a large national database. A national surgical outcomes database, the American College of SurgeoneNational Surgical Quality Improvement Program registry, was queried for data on all patients undergoing open partial nephrectomy (OPN), minimally invasive (laparoscopic þ robotic) partial nephrectomy (MIPN), and minimally invasive radical nephrectomy (MIRN) in 2011 and 2012. Patients undergoing these procedures were identified using the Current Procedural Terminology codes. The primary outcome was unplanned 30-day hospital readmission. A multivariate logistic regression model was constructed to assess for factors independently associated with the primary outcome. Overall, 5276 cases were identified and included in the analysis: 1411 OPN (26.7%), 2210 MIPN (41.8%), and 1655 MIRN (31.3%). Overall, the 30-day readmission rate was 5.9% (7.8% for OPN, 4.5% for MIPN, and 6.1% for MIRN). On multivariate analysis, the odds for 30-day readmission for MIPN was approximately 70% that of OPN (P ¼ .012). The odds for 30-day readmission for 2012 was about 80% of that of 2011 (P 10 and/or condition index >10) with the rest of the variables in the matrix were dropped from the list of variables used in the multivariate study. The remaining independent variables were analyzed using backward logistic regression methods. The final reduced model contained only those covariates exhibiting significant correlation (P < .05) with the outcome.
Outcomes
RESULTS
The primary outcome was unplanned hospital readmission within 30 days of the index surgical procedures. Readmissions included hospitalization to either the same or another hospital after the initial surgical procedure. Hospitalizations within 30 days of discharge that were planned at the time of surgery were not included. The ACS-NSQIP participant use readmission data file has been previously validated and shown to accurately capture unplanned readmission events.10 Preoperative variables collected by NSQIP include demographic data (age, gender, race, body mass index, smoking status, and steroid use) and baseline medical comorbidities (diabetes mellitus, dyspnea, chronic obstructive pulmonary disease, pneumonia, congestive heart failure, history of myocardial infarction, previous percutaneous coronary intervention, previous cardiac surgery, angina, peripheral vascular disease, hypertension, renal failure, dialysis, transient ischemic attack, cerebrovascular accident, bleeding disorder [any condition placing the patient at risk for excessive bleeding requiring hospitalization owing to a deficiency of blood clotting elements: vitamin K deficiency, hemophilia, thrombocytopenia, chronic anticoagulation therapy that has not been discontinued before surgery], preoperative transfusion, and American Society of Anesthesiology [ASA] class). For the purpose of the analysis, some variables were grouped by combining predefined NSQIP variables: dyspnea, chronic obstructive pulmonary
Overall, 5276 patients were identified and included in the analysis: 1411 OPN (26.7%), 2210 MIPN (41.8%), and 1655 MIRN (31.3%; Table 1). Patients in the MIRN group were older (63.0 12.9 years; P
