Impact of Patient, Surgical, and Perioperative Factors on Discharge Disposition after Radical Cystectomy

SIMPLE SUMMARY: Radical cystectomy is a surgical procedure used in the treatment of bladder cancer. It can potentially cure a patient of their disease, but it is associated with risks including long hospital stays and high complication rates. Here, we evaluated how certain factors related to a patient and/or their surgery may impact their discharge to home versus to a rehabilitation facility after surgery. This study found that patients that are older, living alone prior to surgery, and/or have a major post-operative complication are more likely to be discharged to a rehabilitation facility. Recognizing these factors prior to surgery may help identify which patients may require discharge to a rehabilitation facility and can help patients and urologists better plan for the postoperative course. ABSTRACT: Radical cystectomy (RC) is a complex procedure associated with lengthy hospital stays and high complication and readmission rates. We evaluated the impact of patient, surgical, and perioperative factors on discharge disposition following RC at a tertiary referral center. From 2012 to 2019, all bladder cancer patients undergoing RC at our institution were identified (n = 1153). Patients were classified based on discharge disposition: to home or to continued facility-based rehabilitation centers (CFRs, n = 180 (15.61%) patients). On multivariate analysis of patient factors only, age [Risk Ratio (RR): 1.07, p < 0.001)], single marital status (RR: 1.09, p < 0.001), and living alone prior to surgery (RR: 2.55, p = 0.004) were significant predictors of discharge to CFRs. Multivariate analysis of patient, surgical, and perioperative factors indicated age (RR: 1.09, p < 0.001), single marital status (RR: 3.9, p < 0.001), living alone prior to surgery (RR: 2.42, p = 0.01), and major post-operative (Clavien > 3) complications (RR: 3.44, p < 0.001) were significant independent predictors of discharge to CFRs. Of note, ERAS did not significantly impact discharge disposition. Specific patient and perioperative factors significantly impact discharge disposition. Patients who are older, living alone prior to surgery, and/or have a major post-operative complication are more likely to be discharged to CFRs after RC.