The study, published in Supportive Care in Cancer, enrolled 267 patients who underwent bladder perfusion at Shanghai General Hospital between August 2021 and January 2024. Bladder perfusion, in which therapeutic agents such as chemotherapy drugs are instilled directly into the bladder, is a mainstay of treatment for non-muscle-invasive bladder cancer and related conditions. Although the procedure avoids many of the systemic side effects of intravenous chemotherapy, it imposes a demanding schedule of hospital visits, catheterizations, and symptom management, and readmission remains a common and costly part of the patient journey.

To capture how patients were really doing, the team used the SF-36 questionnaire, one of the most widely validated instruments in outcomes research. The SF-36 measures health across ten domains, including physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health. These domains can be aggregated into two summary scores: the Physical Component Summary, or PCS, and the Mental Component Summary, or MCS. Patients completed the survey one week after the induction of bladder perfusion, a timepoint the researchers labeled T0, and again eight weeks later, labeled T1.

The researchers then tracked readmissions over a follow-up window of fourteen months. The results were striking: 131 of the 267 patients were readmitted, an incidence rate of 49.1 percent, with a median time to readmission of 7.2 months, and an interquartile range spanning 4.2 to 10.9 months. In other words, nearly half of the cohort returned to the hospital within roughly a year of starting treatment, underscoring the substantial burden that bladder perfusion patients continue to carry after their initial therapy.

With the readmission data in hand, the team constructed Cox proportional hazards regression models, the standard statistical framework for analyzing time-to-event outcomes. Three separate models were built: one using the T0 quality of life scores, one using the T1 scores, and one using the change scores between the two timepoints. This longitudinal design is what distinguishes the study from much of the existing literature, which typically relies on a single snapshot of quality of life. By modeling both the level and the trajectory of patient-reported health, the researchers could ask not just whether patients felt good at one moment, but whether changes in how they felt carried prognostic information of their own.

The answer, in short, was yes, and the details were revealing. In the T0 model, four of the ten SF-36 domains showed statistically significant associations with time to readmission: the Physical Component Summary, physical functioning, role-physical, and general health, all at P values below 0.05. In the T1 model, the picture broadened considerably, with eight of the ten domains reaching significance, everything except bodily pain and mental health. In the change-score model, six domains were significant: the Physical Component Summary, physical functioning, role-physical, general health, role-emotional, and social functioning. The pattern across the three models was consistent: post-treatment quality of life at eight weeks showed the strongest associations with readmission timing, followed by the change between the two assessments, while the pre-treatment baseline showed the fewest significant links.

Perhaps the most consequential finding concerned the divide between physical and psychological indicators. Across all three models, the physiological dimensions, anchored by the Physical Component Summary and its component domains, were significantly more strongly associated with time to readmission than the psychological dimensions captured by the Mental Component Summary. The differences were statistically significant in each model, with P values of 0.023, less than 0.001, and 0.017 for the T0, T1, and change models respectively. This suggests that in this population, the body’s report on its own condition, the ability to walk, to work, to perform daily tasks, and to perceive one’s general health, carries more prognostic weight than mood or emotional functioning alone.

The authors are careful to frame these findings as hypothesis-generating rather than definitive. Observational designs cannot establish that improving quality of life would directly delay readmission, and the study did not incorporate the full range of clinical variables, such as tumor characteristics, treatment intensity, and comorbidity burden, that would be needed to test whether quality of life adds predictive value beyond established clinical risk factors. The researchers explicitly call for further investigation in studies with more comprehensive clinical data. Still, the consistency of the associations across three separate modeling approaches, and the coherent pattern of physical dominance, lends weight to the central claim that longitudinal quality of life measurement carries real prognostic signal.

The practical implications are nonetheless significant. If quality of life scores collected during bladder perfusion can flag patients at risk of early readmission, clinicians could target supportive interventions, from symptom management and physical rehabilitation to closer follow-up scheduling, at those who need them most. The finding that post-treatment scores at eight weeks are the most informative suggests a concrete operational window: a routine SF-36 assessment at that timepoint could serve as a triage tool, identifying patients whose declining physical function warrants intensified monitoring. This aligns with a broader movement in oncology toward systematic patient-reported outcome monitoring, exemplified by trials showing that electronic symptom tracking during cancer treatment can improve outcomes.

The study also fills a gap in a literature that has largely focused on survival rather than readmission. Previous work has established that health-related quality of life predicts survival in cancer populations, including patients with lung and bladder cancers, and that bladder cancer and its treatments impose lasting burdens on physical function and daily life. By extending this logic to time to readmission, a metric that matters to patients, families, and health systems alike, the Shanghai team connects the subjective experience of treatment with a hard operational outcome. For a therapy that requires patients to return repeatedly for instillations, the distance between scheduled visits and unscheduled readmissions is where much of the disease burden lives, and the new results suggest that listening carefully to how patients describe their own health, especially their physical health, may help clinicians extend that distance.

Subject of Research: Longitudinal health-related quality of life as a predictor of time to hospital readmission in bladder perfusion patients

Article Title: Longitudinal data on health-related quality of life and its association with time to readmission in bladder perfusion patients

Article References: Zhang, M., Chen, Z., Chen, Y., & Zhou, Y. (2026). Longitudinal data on health-related quality of life and its association with time to readmission in bladder perfusion patients. Supportive Care in Cancer, 34(10), Article 1032. https://doi.org/10.1007/s00520-026-11243-3

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11243-3

Keywords: bladder perfusion, health-related quality of life, readmission, SF-36, non-muscle-invasive bladder cancer, Cox proportional hazards, patient-reported outcomes, supportive care, longitudinal study, prognosis, intravesical therapy, nursing research

The retrospective analysis covered 263 consecutive patients operated on between November 2022 and December 2023. Of these, 146 patients — 55.5 percent — were discharged on post-operative day one, or POD1 in the shorthand of surgical teams. The number is striking because early discharge after craniotomy remains rare in routine neurosurgical practice globally, even though evidence has been accumulating for years that many post-operative complications reveal themselves within hours rather than days of surgery. Southampton has been quietly refining its early discharge strategy since 2006, and the pathway evaluated in this study is the product of nearly two decades of institutional experience.

The safety signal is the core of the story. Across the entire cohort, 8.0 percent of patients were readmitted to hospital unplanned within 30 days of discharge. Among those sent home on day one, the figure was almost identical at 7.5 percent. Statistically, the team found no significant association between early discharge and readmission, with an odds ratio of 0.87 and a confidence interval that comfortably spans unity. In other words, going home quickly did not make patients more likely to bounce back through the emergency department door. Mean time to readmission was 9.9 days in the early discharge group, suggesting problems, when they emerged, did so on a timeline largely independent of when patients left hospital.

The study also measured something more revealing than readmission alone: cumulative hospital days within 30 days of surgery. Patients discharged on POD1 accumulated a mean of just 1.0 hospital day, compared with 7.0 days among those requiring prolonged admission. This metric matters because it captures whether savings from early discharge are simply eaten up by later readmissions. In Southampton’s data, they were not. The one-day cohort occasionally did return — a small number needed stays averaging 5.4 days when they did — but the arithmetic still came out overwhelmingly in favour of getting patients home.

The pathway itself is a structured blend of pre-operative selection and same-day logistics. Candidates for early discharge needed good baseline functional status, no major medical frailty, an anticipated uncomplicated recovery, and the ability to mobilise safely. Final eligibility demanded four checkpoints: completion of a post-operative MRI, clearance from physiotherapy and occupational therapy, a stable neurological examination, and overall medical fitness. Patients left with a printed discharge summary, written instructions on warning signs after craniotomy, verbal briefing from ward nurses, and a direct phone line to the neuro-oncology clinical nurse specialist. Follow-up happened through a telephone clinic once histopathology results were available, and the team cross-checked regional referral systems and contacted peripheral hospitals by phone to catch readmissions anywhere in the network.

What stopped the other patients from going home early? The answer, overwhelmingly, was what happened in the immediate hours after surgery. Post-operative adverse events reduced the odds of POD1 discharge by 82 percent, and new or worsened neurological deficits — affecting movement, speech, sensation, vision or cognition — reduced them by 95 percent. Dysphasia was the most common deficit among those with prolonged admissions. Diabetes mellitus was the only pre-operative factor that significantly predicted a longer stay, cutting the odds of early discharge by more than half, though interestingly, peri-operative corticosteroid use in diabetic patients showed no link to discharge timing, and none of the readmitted patients came back with diabetes-related complications. The authors suggest the diabetes finding reflects clinical caution rather than genuine metabolic risk.

On the readmission side, one anatomical factor stood out: tumours in eloquent brain regions — areas controlling speech, movement or other critical functions — tripled the odds of an unplanned return to hospital, with an odds ratio of 3.35. The pattern extended to the reasons for those returns. Patients with eloquent-region tumours were most often readmitted with seizures, while those with tumours elsewhere mostly came back with weakness. The implication is sobering: even when surgery near functional brain areas goes smoothly and patients pass all discharge criteria, they carry a heightened risk of delayed neurological deterioration that only shows up after they are home. Targeted monitoring for this subgroup could be the next logical refinement of the pathway.

Some associations in the data resist easy explanation and the authors urge caution. Higher World Health Organization tumour grade and IDH wildtype status were both linked to a greater likelihood of early discharge, a counterintuitive result the team attributes to unmeasured confounding or selection effects rather than any biological mechanism. Posterior fossa tumours, located at the base of the skull near brainstem structures, also proved difficult: only nine of 25 such patients achieved POD1 discharge, and the rest averaged eight days in hospital. Meanwhile, the absence of a significant link between WHO Performance Status and discharge timing likely reflects the fact that patients with poor functional status were screened out of the pathway before the analysis even began.

Not every barrier to early discharge was medical. Among patients with no adverse events, no deficits and no imaging delays, prolonged admission was mostly attributable to waiting for physiotherapy and occupational therapy clearance — an operational bottleneck rather than a clinical one. Delayed post-operative MRI, which in principle should gate same-day discharge, affected only five patients in the entire cohort, with 98.1 percent of scans completed within 24 hours. The lesson for hospitals hoping to copy the model is that early discharge is as much a systems-engineering problem as a surgical one: it requires allied health assessment, imaging capacity and telephone follow-up infrastructure to move in lockstep with the operating theatre.

The limitations of the study are real. It is retrospective, so patients were never randomly assigned to early or prolonged discharge, and the 55.5 percent who went home on day one were by definition a selected, healthier subgroup. Only 21 readmission events occurred, yielding wide confidence intervals, and the analyses were univariable, leaving open the possibility of residual confounding. The authors do not claim equivalence between discharge strategies; they claim something narrower and more defensible — that in carefully chosen patients, structured day-one discharge is achievable without an observed rise in short-term readmission, and that the barriers to it are identifiable and, in many cases, modifiable. As neuro-oncology caseloads grow and hospital beds become scarcer, the ability to safely compress recovery into 24 hours offers a rare win on three fronts at once: better patient flow, lower cost, and the chance for people facing a life-limiting diagnosis to heal where most of them would prefer to be — at home.

Subject of Research: Feasibility and safety of post-operative day one discharge after craniotomy for brain tumour resection

Article Title: Post-operative day one discharge following craniotomy for tumour resection

Article References: Yogeswaran, K., Ewbank, F., Khoo, R., O’flaherty, D., Islam, M., Kaldas, A., Zafar, A., Durnford, A., Grundy, P., & Roach, J. (2026). Post-operative day one discharge following craniotomy for tumour resection. Journal of Neuro-Oncology, 179(3), Article 99. https://doi.org/10.1007/s11060-026-05790-2

Image Credits: AI Generated

DOI: 10.1007/s11060-026-05790-2

Keywords: craniotomy, brain tumour, neuro-oncology, early discharge, readmission, enhanced recovery, length of stay, neurosurgery, eloquent cortex, POD1 discharge, Post-operative, discharge