A Multi-Pronged Intervention to Reduce Readmissions and Readmission Intensity after Radical Cystectomy.
OBJECTIVE
To develop a multi-pronged, evidence-based protocol to reduce readmission risk and readmission intensity, as represented by the duration of the index readmission, after radical cystectomy.


MATERIALS AND METHODS
A per-protocol study was performed. The protocol included preoperative nutritional supplementation, early stent removal, and a follow-up phone call within 4-5 days of discharge. The pre-protocol period was from February 1,2020 to July 31,2021 and the post-protocol period was from December 1, 2020 to November 31, 2021. Using multivariate regression models, we compared outcomes among patients treated with radical cystectomy before and after protocol initiation.


RESULTS
We identified 70 pre-protocol patients and 126 post-protocol patients. After adjusting for age, sex, BMI, and frailty score, there was a significant reduction in 90-day readmission intensity (7 vs 5 days; p=0.048) among post-protocol patients.


CONCLUSIONS
After implementation of an evidence-based protocol for patients undergoing radical 90-day readmission intensity decreased significantly. This protocol may move the needle forward on reducing readmissions, but a larger randomized trial is needed.