A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer Journal Article

Authors: Mukkala, A. N.; Song, J. B.; Lee, M.; Boasie, A.; Irish, J.; Finelli, A.; Wei, A. C.
Article Title: A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer
Abstract: Introduction: Unplanned visits (UPV) - re-admissions and emergency room (ER) visits - are markers of healthcare system quality. Radical prostatectomy (RP) is a commonly performed cancer procedure, where variation in UPV represents a gap in care for prostate cancer patients. Here, we systematically synthesize the rates, reasons, predictors, and interventions for UPV after RP, to inform evidence-based quality improvement (QI) initiatives. Methods: A systematic review was performed for studies from 2000-2020 using keywords: "readmission,""emergency room/department,""unplanned visit,"and "prostatectomy."Studies that focused on UPV following RP and that reported rates, reasons, predictors, or interventions, were included. Data was extracted via a standardized form. Meta-analysis was completed. Results: Sixty studies, with 406 107 RP patients, were eligible; 16 028 UPV events (-5%) were analyzed from 317 050 RP patients. UPV rates after RP varied between studies (ER visit range 6-24%; re-admissions range 0-56%). The 30-day and 90-day ER visit rates were 12% and 14%, respectively; the 30-day and 90-day re-admission rates were 4% and 9%, respectively. A total of 55% of all re-admissions after RP are directly due to postoperative genitourinary (GU)-related complications such as strictures, obstructions, fistula, bladder-related, incontinence, urine leak, renal problems, and other unspecified urinary complications. The next most common readmission reasons were anastomosis-related, infection-related, cardiovascular/pulmonary events, and wound-related issues. Thirty-four percent of all ER visits after RP are directly due to urinerelated issues such as retention, urinoma, obstruction, leak, and catheter problems. The next most common ER visit reasons were abdominal/gastrointestinal issues, infection-related, venous thromboembolic events, and wound-related issues. Predictors for increased re-admission included: Open RP, lymph node dissection, Charlson comorbidity index≥2, low surgeon/hospital case volume, and socioeconomic determinants of health. Of the 10 interventions evaluated, a 3.4% average reduction in UPV rate was observed, highlighting an approximate two-fold decrease. Meta-analysis demonstrated a significant benefit of interventions over controls with odds ratio 0.62 (95% confidence interval 0.46-0.84). Interventions that used multidisciplinary, nurse-centered, programs, with patient self-care/empowerment were more beneficial than algorithmic patient care pathways and preoperative patient education. Conclusions: Twenty years of international, retrospective, experience suggests UPV after RP are often related to GU complications, infection- or wound-related factors. QI interventions to reduce UPV should target these factors. While many re-admissions after RP appear to be unavoidable, ER visits have more opportunity for volume reduction by QI. The interventions evaluated herein have potential to reduce UPV after RP. © 2021 Canadian Urological Association.
Keywords: cancer surgery; constipation; review; lymph node dissection; kidney disease; lung disease; incidence; abdominal pain; prostate cancer; postoperative complication; gleason score; emergency ward; systematic review; urine incontinence; prostatectomy; cardiovascular disease; hernia; urinary tract infection; jaundice; postoperative infection; sepsis; medline; health care system; hospital admission; epididymitis; orchitis; hospital readmission; anastomosis; urogenital tract disease; ileus; urine retention; gastrointestinal disease; wound dehiscence; wound complication; socioeconomics; meta analysis; sclerosis; venous thromboembolism; cellulitis; embase; surgical volume; abscess; catheter complication; lymphocele; urinoma; hospital volume; bladder obstruction; charlson comorbidity index; human; bladder fistula; urethra stenosis; unplanned visit
Journal Title: Canadian Urological Association Journal
Volume: 15
Issue: 10
ISSN: 1920-1214
Publisher: Canadian Urological Association  
Date Published: 2021-10-01
Start Page: E531
End Page: E544
Language: English
DOI: 10.5489/cuaj.6931
PROVIDER: scopus
PUBMED: 33750517
PMCID: PMC8525525
Notes: Review -- Export Date: 3 May 2021 -- Source: Scopus
Citation Impact
MSK Authors
  1. Alice Chia-Chi Wei
    43 Wei