Introduction: Radical cystectomy (RC) remains the mainstay of treatment for muscle-invasive bladder cancer. Discharge disposition (DD) following RC - either home or to a continued rehabilitation facility (CRF) – is a clinical decision based on several clinical measures. Given that DD can have a dramatic impact on patient expense and recovery, the purpose of this study is to assess predictors of DD after undergoing RC for bladder cancer in the United States. Methods: This study is a retrospective, cohort study. Patients were divided into two cohorts: those discharged home and those discharged to CRF. We examined patient, surgical, and hospital characteristics. Multivariable logistic regression models were used to control for selected variables. All statistical tests were two-sided. Patients were derived from the Premier Healthcare Database. International classification of disease (ICD)-9 ( <2014), ICD-10 (= 2015), and Current Procedural Terminology (CPT) codes were used to identify patient diagnoses and encounters. The population consisted of 138,151 patients who underwent RC for bladder cancer between January 1, 2000 and December 31, 2019. Results: A total of 24,922 (18.0%) of patients were admitted to CRFs. Multivariate analysis revealed that older age [Odds Ratio (OR):1.066, 95% Confidence Interval (CI): 1.063-1.068], single/widowed marital status [OR:2.232, 95%CI:2.160-2.307], female gender [OR:1.444, 95%CI:1.392-1.497], increased Charlson Comorbidity Index (CCI) [CCI=1 OR:1.285, 95%CI:1.162-1.421] [CCI=2 OR:2.123, 95%CI:1.976-2.281], Medicaid [OR:1.949, 95%CI:1.785-2.129], and Medicare insurance [OR:1.870, 95%CI:1.774-2.129] are associated with CRF discharge. Rural hospital location [OR:0.873, 95%CI:0.824-0.925], self-pay status [OR:0.710, 95%CI:0.565-0.891], increased annual surgeon case [OR:0.660, 95%CI:0.624-0.697], and robotic surgical approach [OR:0.777, 95%CI:0.744-0.811] are associated with home discharge. Conclusions: Several specific patient, surgical, and facility characteristics were identified that may significantly impact DD after RC for bladder cancer. This new information should help with preoperative counseling and shared decision-making. SOURCE OF Funding: N/A
.jpg "Raj Anirudh Kumar, BS photo")
