Introduction: Little is known regarding national numbers of patients undergoing urinary diversion for neurogenic bladder and their readmission rates outside of the Medicare population. We sought herein to evaluate the 90 day readmission rates using a nationally representative database.
Methods: Using 2016-2017 data from the National Readmissions Database (NRD), we identified adult neurogenic bladder patients who underwent hospitalization for urinary diversion without cancer and applied NRD discharge weights to generate national population estimates. Descriptive analysis was performed. A multivariate logistic regression model was used to evaluate odds of readmission controlling for clinically relevant variables.
Results: An estimated 296 urinary diversions for neurogenic bladder were performed in adults from 2016-2017 with average (SD) age of 50.4 (15.9). Fifty-seven percent were female. The primary payer was Medicare for 58.4%, Private insurance for 21.1%, and Medicaid or other for 20.5%. Sixty-six percent of patients lived in a county with more than 250,000 population. Ninety percent of cases were performed at teaching hospitals.
Paraplegia or quadriplegia was listed as the etiology of neurogenic bladder for 32.5% of patients, spina bifida or cerebral palsy for 19.8% of patients, and unspecified etiology for the remaining. The mean (SD) Charlson Comorbidity Index score was 2.0 (1.9). Pre-admission to the hospital occurred for 46.9%. Cystectomy was performed in 33.5% of cases. Median (IQR) length of hospitalization was 7 (5-11) days. The most common dispositions at discharge were to home or acute rehab (25.9%), to a skilled nursing facility or intermediate care facility (26.1%), or home with home health care (48.0%). Too few mortalities were reported to include. Seventy-six patients were readmitted to the hospital an average (SD) 35.9 (21.7) days after surgery. Adjusting for comorbidities, etiology of neurogenic bladder, and discharge disposition, patients that were preadmitted to the hospital were at 11.0 times increased odds of readmission (p < 0.001). Examining the impact of zip code income quartile and payer type, there were no differences in patients requiring readmission.
Conclusions: One quarter of patients undergoing urinary diversion for neurogenic bladder required readmission to the hospital within 90 days of discharge, and nearly half of these are after the traditional 30 day window of readmission. Improved counseling of patients may assist with preventing readmissions.