Identifying High-Risk Patients for Hospital Readmission Following Radical Cystectomy and Urinary Diversion

2014 ◽  
Vol 186 (2) ◽  
pp. 496
Author(s):  
K.E. Omernick ◽  
S.E. Tevis ◽  
G.E. Leverson ◽  
E.J. Abel ◽  
D.F. Jarrard ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Hospital Readmission ◽  
High Risk Patients ◽  
Risk Patients

Development and validation of the Tool for Pharmacists to Predict 30-day hospital readmission in patients with Heart Failure (ToPP-HF)

2021 ◽  
Author(s):  
Melissa R Riester ◽  
Laura McAuliffe ◽  
Christine Collins ◽  
Andrew R Zullo
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Hospital Readmission ◽  
Left Ventricular Ejection ◽  
Day Hospital ◽  
High Risk Patients ◽  
C Statistic ◽  
Patients With Heart Failure ◽  
Risk Patients ◽  
Development And Validation

Abstract Purpose Pharmacists are well positioned to provide transitions of care (TOC) services to patients with heart failure (HF); however, hospitalizations for patients with HF likely exceed the capacity of a TOC pharmacist. We developed and validated a tool to help pharmacists efficiently identify high-risk patients with HF and maximize their potential impact by intervening on patients at the highest risk for 30-day all-cause readmission. Methods We conducted a retrospective cohort study including adults with HF admitted to a health system between October 1, 2016, and October 31, 2019. We randomly divided the cohort into development (n = 2,114) and validation (n = 1,089) subcohorts. Nine models were applied to select the most important predictors of 30-day readmission. The final tool, called the Tool for Pharmacists to Predict 30-day hospital readmission in patients with Heart Failure (ToPP-HF) relied upon multivariable logistic regression. We assessed discriminative ability using the C statistic and calibration using the Hosmer-Lemeshow goodness-of-fit test. Results The risk of 30-day all-cause readmission was 15.7% (n = 331) and 18.8% (n = 205) in the development and validation subcohorts, respectively. The ToPP-HF tool included 13 variables: number of hospital admissions in previous 6 months; admission diagnosis of HF; number of scheduled medications; chronic obstructive pulmonary disease diagnosis; number of comorbidities; estimated glomerular filtration rate; hospital length of stay; left ventricular ejection fraction; critical care requirement; renin-angiotensin-aldosterone system inhibitor use; antiarrhythmic use; hypokalemia; and serum sodium. Discriminatory performance (C statistic of 0.69; 95% confidence interval [CI], 0.65-0.73) and calibration (Hosmer-Lemeshow P = 0.28) were good. Conclusions The ToPP-HF performs well and can help pharmacists identify high-risk patients with HF most likely to benefit from TOC services.

scholarly journals Re-operation within 30 days of radical cystectomy: Identifying high-risk patients and complications using ACS-NSQIP database

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Rashid K. Sayyid ◽  
Diana Magee ◽  
Amanda E. Hird ◽  
Benjamin T. Harper ◽  
Eric Webb ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
African American ◽  
High Risk ◽  
Radical Cystectomy ◽  
High Risk Patients ◽  
Metastatic Bladder Cancer ◽  
Risk Patients ◽  
History Of ◽  
African American Race

Introduction: Radical cystectomy (RC) is a highly morbid procedure, with 30-day complication rates approaching 31%. Our objective was to determine risk factors for re-operation within 30 days following a RC for non-metastatic bladder cancer. Methods: We included all patients who underwent a RC for non-metastatic bladder cancer using The American College of Surgeons National Surgical Quality Improvement Program database between January 1, 2007 and December 31, 2014. Logistic regression analyses were used to evaluate predictors of re-operation. Results: A total of 2608 patients were included; 5.8% of patients underwent re-operation within 30 days. On multivariable analysis, increasing body mass index (BMI) (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01–1.07), African-American race (vs. Caucasian OR 2.29; 95% CI 1.21–4.34), and history of chronic obstructive pulmonary disease (COPD) (OR 2.33; 95% CI 1.45–3.74) were significant predictors of re-operation within 30 days of RC. Urinary diversion type (ileal conduit vs. continent) and history of chemotherapy or radiotherapy within 30 days prior to RC were not. Patients who underwent re-operation within this timeframe had a significantly higher mortality rate (4.0% vs. 1.6%) and were more likely to experience cardiac (7.2% vs. 1.9%), pulmonary (23.0% vs. 3.0%), neurological (2.0% vs. 0.49%), and venous thromboembolic events (10.5% vs. 5.4%), as well as infectious complications (64.5% vs. 24.1%) with a significantly longer hospital length of stay (16.5 vs. 7.0 days). Conclusions: Recognizing increasing BMI, COPD, and African-American race as risk factors for re-operation within 30 days of RC will allow urologists to preoperatively identify such high-risk patients and prompt them to adopt more aggressive approaches to minimize postoperative surgical complications.

scholarly journals Radical cystectomy for high risk patients with superficial bladder cancer in the era of orthotopic urinary reconstruction

Cancer ◽  
1995 ◽  
Vol 76 (5) ◽  
pp. 833-839 ◽  
Author(s):  
John A. Freeman ◽  
David Esrig ◽  
John P. Stein ◽  
Anne R. Simoneau ◽  
Eila C. Skinner ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Radical Cystectomy ◽  
Superficial Bladder Cancer ◽  
High Risk Patients ◽  
Risk Patients ◽  
Urinary Reconstruction

Quality of Life and Overall Survival in High Risk Patients After Radical Cystectomy With a Simple Urinary Derivation

2015 ◽  
Vol 93 (6) ◽  
pp. 368-374
Author(s):  
Giuseppe Mucciardi ◽  
Luciano Macchione ◽  
Alessandro Galì ◽  
Antonina di Benedetto ◽  
Enrica Subba ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Overall Survival ◽  
High Risk ◽  
Radical Cystectomy ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals The heterogeneous health state profiles of high-risk healthcare utilizers and their longitudinal hospital readmission and mortality patterns

2019 ◽  
Author(s):  
Shawn Choon Wee Ng ◽  
Yu Heng Kwan ◽  
Shi Yan ◽  
Chuen Seng Tan ◽  
Lian Leng Low
Keyword(s):  
High Risk ◽  
Hospital Readmission ◽  
Latent Class ◽  
Resource Planning ◽  
Transitions Of Care ◽  
High Risk Population ◽  
Health State ◽  
High Risk Patients ◽  
Class 1 ◽  
Risk Patients

Abstract Background: High-risk patients are most vulnerable during transitions of care. Due to the high burden of resource allocation for such patients, we hypothesize that segmentation of this heterogeneous population into distinct subgroups will enable improved healthcare resource planning. In this study, we segmented a high-risk population with the aim to identify and characterize a patient subgroup with the highest 30-day and 90-day hospital readmission and mortality. Methods: We extracted data from our transitional care program (TCP) from June to November 2018. Latent class analysis (LCA) was used to determine the optimal number and characteristics of latent subgroups, assessed based on model fit and clinical interpretability. Regression analysis was performed to assess the association of class membership on 30- and 90-day all-cause readmission and mortality. Results: Among 752 patients, a 3-class best fit model was selected: Class 1 “Frail, cognitively impaired and physically dependent”, Class 2 “Pre-frail, but largely physically independent” and Class 3 “Physically independent”. The 3 classes have distinct demographics, medical and socioeconomic characteristics (p<0.05), 30- and 90-day readmission (p<0.05) and mortality (p<0.01). Class 1 patients have the highest age-adjusted 90-day readmission (OR=2.04, 95%CI: 1.21-3.46, p= 0.008), 30- (OR=6.92, 95%CI: 1.76-27.21, p=0.006) and 90-day mortality (OR=11.51, 95%CI: 4.57-29.02, p<0.001). Conclusions: We identified a subgroup with the highest readmission and mortality risk amongst high-risk patients. We also found a lack of interventions in our TCP that specifically addresses increased frailty and poor cognition, which are prominent features in this subgroup. These findings will help to inform future program modifications and strengthen existing transitional healthcare structures currently utilized in this patient cohort.

scholarly journals The heterogeneous health state profiles of high-risk healthcare utilizers and their longitudinal hospital readmission and mortality patterns

2019 ◽  
Author(s):  
Shawn Choon Wee Ng ◽  
Yu Heng Kwan ◽  
Shi Yan ◽  
Chuen Seng Tan ◽  
Lian Leng Low
Keyword(s):  
High Risk ◽  
Hospital Readmission ◽  
Latent Class ◽  
Resource Planning ◽  
Transitions Of Care ◽  
High Risk Population ◽  
Health State ◽  
High Risk Patients ◽  
Class 1 ◽  
Risk Patients

Abstract Background: High-risk patients are most vulnerable during transitions of care. Due to the high burden of resource allocation for such patients, we propose that segmentation of this heterogeneous population into distinct subgroups will enable improved healthcare resource planning. In this study, we segmented a high-risk population with the aim to identify and characterize a patient subgroup with the highest 30-day and 90-day hospital readmission and mortality. Methods: We extracted data from our transitional care program (TCP), a Hospital-to-Home program launched by the Singapore Ministry of Health, from June to November 2018. Latent class analysis (LCA) was used to determine the optimal number and characteristics of latent subgroups, assessed based on model fit and clinical interpretability. Regression analysis was performed to assess the association of class membership on 30- and 90-day all-cause readmission and mortality. Results: Among 752 patients, a 3-class best fit model was selected: Class 1 “Frail, cognitively impaired and physically dependent”, Class 2 “Pre-frail, but largely physically independent” and Class 3 “Physically independent”. The 3 classes have distinct demographics, medical and socioeconomic characteristics (p<0.05), 30- and 90-day readmission (p<0.05) and mortality (p<0.01). Class 1 patients have the highest age-adjusted 90-day readmission (OR=2.04, 95%CI: 1.21-3.46, p= 0.008), 30- (OR=6.92, 95%CI: 1.76-27.21, p=0.006) and 90-day mortality (OR=11.51, 95%CI: 4.57-29.02, p<0.001). Conclusions: We identified a subgroup with the highest readmission and mortality risk amongst high-risk patients. We also found a lack of interventions in our TCP that specifically addresses increased frailty and poor cognition, which are prominent features in this subgroup. These findings will help to inform future program modifications and strengthen existing transitional healthcare structures currently utilized in this patient cohort.

scholarly journals The heterogeneous health state profiles of high-risk healthcare utilizers and their longitudinal hospital readmission and mortality patterns

2019 ◽  
Author(s):  
Shawn Choon Wee Ng ◽  
Yu Heng Kwan ◽  
Shi Yan ◽  
Chuen Seng Tan ◽  
Lian Leng Low
Keyword(s):  
High Risk ◽  
Hospital Readmission ◽  
Latent Class ◽  
Resource Planning ◽  
Transitions Of Care ◽  
High Risk Population ◽  
Health State ◽  
High Risk Patients ◽  
Class 1 ◽  
Risk Patients

Abstract Background: High-risk patients are most vulnerable during transitions of care. Due to the high burden of resource allocation for such patients, we hypothesize that segmentation of this heterogeneous population into distinct subgroups will enable improved healthcare resource planning. In this study, we segmented a high-risk population with the aim to identify and characterize a patient subgroup with the highest 30-day and 90-day hospital readmission and mortality. Methods: We extracted data from our transitional care program (TCP) from June to November 2018. Latent class analysis (LCA) was used to determine the optimal number and characteristics of latent subgroups, assessed based on model fit and clinical interpretability. Regression analysis was performed to assess the association of class membership on 30- and 90-day all-cause readmission and mortality. Results: Among 752 patients, a 3-class best fit model was selected: Class 1 “Frail, cognitively impaired and physically dependent”, Class 2 “Pre-frail, but largely physically independent” and Class 3 “Physically independent”. The 3 classes have distinct demographics, medical and socioeconomic characteristics (p<0.05), 30- and 90-day readmission (p<0.05) and mortality (p<0.01). Class 1 patients have the highest age-adjusted 90-day readmission (OR=2.04, 95%CI: 1.21-3.46, p= 0.008), 30- (OR=6.92, 95%CI: 1.76-27.21, p=0.006) and 90-day mortality (OR=11.51, 95%CI: 4.57-29.02, p<0.001). Conclusions: We identified a subgroup with the highest readmission and mortality risk amongst high-risk patients. We also found a lack of interventions in our TCP that specifically addresses increased frailty and poor cognition, which are prominent features in this subgroup. These findings will help to inform future program modifications and strengthen existing transitional healthcare structures currently utilized in this patient cohort.

Postoperative complications and 90-day mortality in radical cystectomy in high-risk patients: A monocentric retrospective observational study

2018 ◽  
Vol 85 (3) ◽  
pp. 111-117 ◽  
Author(s):  
Carlo Pavone ◽  
Luigi Candela ◽  
Dario Fontana ◽  
Alchiede Simonato
Keyword(s):  
High Risk ◽  
Postoperative Complications ◽  
Observational Study ◽  
Radical Cystectomy ◽  
Charlson Comorbidity Index ◽  
Odds Ratio ◽  
Retrospective Observational Study ◽  
High Risk Patients ◽  
Risk Patients ◽  
Comorbidity Index

Aim: Assessing the incidence of immediate postoperative complications and 90-day mortality in high-risk patients who have undergone radical cystectomy; evaluating the correlation between preoperative conditions and surgery outcomes. Materials and methods: This is a monocentric retrospective observational study in which data of 65 patients have been analyzed. High-risk criteria: (a) Age ≥75 years, (b) obesity, (c) age-adjusted Charlson Comorbidity Index ≥8, (d) anemic status, and (e) pT ≥3. More than 50% of patients had two or more “high-risk” indicators. Postoperative complications were assessed through Clavien–Dindo classification. Results: Average age of patients was 70.4 years, average age-adjusted Charlson Comorbidity Index was 5.8, and average body mass index was 27.5. In 28% of patients, no complications arose, while in 46% grades I–II complications according to Clavien–Dindo occurred, in 23% grades III–IV complications occurred, and in 3% of the patients, death arose in the immediate postoperative period (grade V). Overall, 90-day mortality rate after surgery was 12.3%. The age ≥75 years and an age-adjusted Charlson Comorbidity Index score ≥8 have shown to be risk factors for the onset of severe complications (odds ratio = 3.54, p = 0.028 and odds ratio = 4.7, p = 0.026), while preoperative anemic status was a risk factor for complications in general (odds ratio = 4.1, p = 0.015). No analyzed parameter was a predictor of 90-day mortality ( p > 0.05). Conclusion: Immediate postoperative complications and 90-day mortality in radical cystectomy in high-risk patients remain significant, but still in line with the data in the literature on comparable populations. Some of the preoperative parameters were able to predict the outcomes of the intervention with regard to the onset of complications but not to the 90-day mortality.

scholarly journals Prognostic Role of Programmed Death Ligand-1 on Tumor-Infiltrating Immune Cells in “High-Risk” Patients Following Radical Cystectomy: A Retrospective Cohort Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Chung Un Lee ◽  
Dong Hyeon Lee ◽  
Wan Song
Keyword(s):  
High Risk ◽  
Radical Cystectomy ◽  
Immune Cells ◽  
Tumor Recurrence ◽  
Prognostic Role ◽  
Programmed Death Ligand 1 ◽  
High Risk Patients ◽  
Programmed Death ◽  
Risk Patients

PurposeThe aim of this study is to investigate the prognostic role of programmed death ligand-1 (PD-L1) on tumor-infiltrating immune cells (TIICs) in patients after radical cystectomy (RC) for bladder cancer (BCa).Materials and MethodsWe retrospectively reviewed 92 “high-risk” (≥pT3a and/or pN+) patients who underwent RC for BCa, without adjuvant chemotherapy (AC), between April 2014 and December 2019. PD-L1 on TIICs was measured only using the VENTANA (SP-142) immunohistochemistry assay. Patients were categorized into three groups based to the percentage of the tumor area covered by PD-L1 on TIICs: IC0 (&lt;1%), IC1 (≥1% and &lt;5%), and IC2/3 (≥5%). Positive PD-L1 was defined as IC2/3 (≥5%). Kaplan–Meier survival analysis was used to illustrate recurrence-free survival (RFS), and Cox proportional hazard models were used to identify predictive factors of tumor recurrence.ResultsWithin the cohort, the proportions of PD-L1 IC0, IC1, and IC2/3 were 21.7%, 23.9%, and 54.4%, respectively. At follow-up (mean 31.3 months), tumor recurrence was identified in 49 patients (53.3%). Using multivariable analysis, tumor stage (pT4; P=0.005), positive lymph nodes (P=0.021), and positive PD-L1 on TIICs (P=0.010) were independent predictors of tumor recurrence. The 2- and 3-year RFS rates were 67.7% and 64.2% in negative PD-L1 on TIICs, while 27.8% and 22.3% in positive PD-L1 on TIICs, respectively.ConclusionsPositive PD-L1 on TIICs was significantly associated with poorer RFS in “high-risk” patients after RC without AC. Our results support the use of adjuvant immunotherapy in “high-risk” patients with positive PD-L1 on TIICs after RC.

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