Incidence and predictors of 30-day readmission in patients treated with robot-assisted radical prostatectomy

INTRODUCTION & OBJECTIVES: Although several studies reported advantages related to the adoption of robot-assisted radical prostatectomy (RARP) in terms of postoperative pain, blood transfusions, and length of hospital stay, evidence is scarce regarding the incidence and predictors of readmission in these patients. MATERIAL & METHODS: Overall, 1,402 consecutive prostate cancer (PCa) patients treated with RARP at a single centre between February 2006 and August 2013 were identified. Baseline comorbidities were categorized according to the Charlson Comorbidity Index (CCI). Post-operative complications during the first hospitalization were both categorized using both the Clavien-Dindo classification system and detailed as follows: bleeding/haematoma, lymphorrhoea/lymphocoeles, fever, urinary fistula, cardiovascular event, and other complications. Patients experiencing 30-day readmission were identified. Uni- and multivariate logistic regression analyses tested the association between 30-day readmission and age at surgery, the receipt of pelvic lymph node dissection, CCI, and the severity of postoperative complications classified according to the Clavien-Dindo system as well as the type of postoperative complications. RESULTS: Mean patient age was 62.7 years (median: 63). Overall, 161 (11.5%) patients experienced a postoperative complication during the first hospitalization. The most frequent type of complication was bleeding/haematoma (6.1%), followed by lymphorrhoea/lymphocoeles (1.4%). Clavien- Dindo distribution during first hospitalization was 0 in 1241 (88.5%), 1 in 53 (3.8%), 2 in 69 (4.9%) and ≥3 in 39 (2.8%) patients. Overall, 38 patients (2.7%) needed a new hospitalization within 30 days after discharge. The most common causes of rehospitalization were fever in 12 patients (31.6%), lymphoceles in 11 (28.9%) and urinary leak in 6 (15.8%). The proportion of patients who experienced 30-day readmission was significantly higher among patients who had a complication during the first hospitalization compared to those who did not experience a complication during the first hospitalization (6.2 vs. 2.3%, respectively; p=0.01). At multivariable analyses, the occurrence of a complication during the first hospitalization and its severity represented independent predictors of 30-day readmission, after accounting for confounders (all P<0.01). When analysing the type of complication, fever (OR: 7.05; p=0.01), urinary fistula (OR: 13.41; p<0.01), and cardiocirculatory complications (OR: 19.05; p<0.001) were significantly associated with 30-day readmission. Of note, age, comorbidity status, and the receipt of pelvic lymph node dissection did not represent independent predictors of 30-day readmission (all p≥0.1). CONCLUSIONS: Our data show that patients undergoing RARP have a relatively low risk of 30-day readmission (2.7%). Of note, the occurrence of a early post-operative complication represented the only independent predictor of 30-day readmission. In this context, fever, urinary fistula, and cardiovascular complications represent the type of complications significantly associated with higher risk o