A Multipronged Intervention to Reduce Readmissions and Readmission Intensity After Radical Cystectomy.

OBJECTIVE: To develop a multipronged, 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 4-5days of discharge. The preprotocol period was from February 1, 2020 to July 31, 2021 and the postprotocol 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 preprotocol patients and 126 postprotocol patients. After adjusting for age, sex, BMI, and frailty score, there was a significant reduction in 90-day readmission intensity (7 vs 5days; P = .048) among postprotocol patients. CONCLUSION: 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.

Acute Kidney Injury Related to Intoxication From Synthetic Cannabis: Don't You Know That You're Toxic?

Acute kidney injury (AKI) occurs infrequently in young patients and often raises concern for irreversible or deadly etiologies. However, AKI related to synthetic marijuana, colloquially known as K2, is an increasingly common phenomenon in the United States and resolves quickly with fluid resuscitation. Here, we present a case of a young male who presented with severe AKI that initially raised concern for the need to start renal replacement therapy. Laboratory testing revealed an elevated osmolar gap and negative urine drug screen, while urinalysis demonstrated acanthocytes, raising concern for toxic alcohol ingestion or vasculitis. Following fluid resuscitation, his renal function improved dramatically, and he was discharged home within days of presentation. K2-related AKI most frequently occurs in young men, mirroring the population that most frequently uses synthetic marijuana. Its exact etiology remains unknown, but direct nephrotoxicity appears to be the most plausible mechanism. No other known case has reported acanthocytes. Although objective data indicates severe illness on presentation, patients often recover rapidly to baseline and often do not suffer long-term renal impairment following conservative management.