Changes in Radical Cystectomy Discharge Disposition During the COVID-19 Pandemic: Data in Support of an Efficient Care Pathway

Purpose: Radical cystectomy is a high-risk procedure commonly followed by discharge to home with home care or long-term care facilities. The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare delivery and discharge practices, offering a natural experiment to assess flexibility in postoperative care pathways. This study evaluates changes in discharge disposition during the pandemic and examines associated patient outcomes.Materials and Methods: We conducted a retrospective cohort study using statewide data from Pennsylvania. Adults who underwent radical cystectomy between quarter (Q) 1 2017 and Q2 2022 were categorized into prepandemic, height of pandemic, and COVID-19 vaccine periods. The primary outcome was discharge disposition: to home with home care, home, or long-term care. Secondary outcomes included 90-day readmission and 90- day mortality. Multinomial logistic regression assessed associations between pandemic period and discharge disposition, adjusting for demographics, comorbidity burden, cancer stage, and length of stay.Results: Among 1,755 patients, discharge to home with home care increased during the pandemic (71% prepandemic, 81% height of pandemic, 74% COVID-19 vaccine period), while long-term care use declined (18%, 5%, 13%). Compared to the prepandemic period, patients were significantly less likely to be discharged to long-term care during the height of the pandemic (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.12–0.42) and in the COVID-19 vaccine period (OR, 0.61; 95% CI, 0.42–0.88). Patient-level predictors of discharge to long-term care included older age, female sex, higher comorbidity burden, and longer hospital stays. Despite changes in disposition, 90-day readmission and 90-day mortality remained clinically stable.Conclusions: Discharge disposition patterns following radical cystectomy did not fully return to prepandemic norms, reflecting lasting changes in healthcare delivery beyond the acute phase of COVID-19. While the use of long-term care declined, outcomes remained stable, supporting the safety of expanded home-based recovery in selected patients. However, a consistent subset of patients continued to require institutional postacute care, suggesting that long-term care utilization is primarily driven by clinical need.