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Implementing a new protocol significantly reduced the duration of hospital readmissions after radical cystectomy. This evidence-based approach shows promise in lowering readmission intensity for patients.

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Area of Science:

  • Urology
  • Surgical Oncology
  • Evidence-Based Medicine

Background:

  • Radical cystectomy is a major surgery with significant readmission rates.
  • Reducing readmission intensity, measured by duration, is crucial for patient recovery and healthcare efficiency.
  • Existing protocols may not adequately address the multifaceted nature of post-cystectomy readmissions.

Purpose of the Study:

  • To develop and evaluate a multipronged, evidence-based protocol to decrease readmission risk and intensity after radical cystectomy.
  • To assess the impact of preoperative nutritional supplementation, early stent removal, and post-discharge follow-up calls on patient outcomes.
  • To quantify the reduction in the duration of index readmissions following protocol implementation.

Main Methods:

  • A per-protocol study comparing pre- and post-protocol implementation periods.
  • Inclusion of preoperative nutritional supplementation, early urinary stent removal, and a follow-up phone call within 4-5 days of discharge.
  • Multivariate regression analysis to compare 90-day readmission intensity between 70 preprotocol and 126 postprotocol patients, adjusting for covariates.

Main Results:

  • A significant reduction in 90-day readmission intensity was observed in the post-protocol group (5 days) compared to the pre-protocol group (7 days).
  • The reduction in readmission intensity remained significant after adjusting for age, sex, BMI, and frailty score (P = .048).
  • The study identified 70 patients in the pre-protocol phase and 126 in the post-protocol phase.

Conclusions:

  • Implementation of the evidence-based protocol led to a significant decrease in 90-day readmission intensity after radical cystectomy.
  • This protocol demonstrates potential for improving patient outcomes by reducing the burden of readmissions.
  • Further validation through a larger randomized controlled trial is recommended to confirm these findings and establish broader clinical utility.