Portal de Periódicos da CAPES

The Effects of Adjusting for Case Mix on Mortality and Length of Stay Following Radical Cystectomy

2006; Lippincott Williams & Wilkins; Volume: 176; Issue: 4 Linguagem: Inglês

10.1016/j.juro.2006.06.015

1527-3792

Brent K. Hollenbeck, David C. Miller, David A. Taub, Rodney L. Dunn, Shukri F. Khuri, William G. Henderson, James E. Montie, Willie Underwood, John T. Wei,

Pelvic floor disorders treatments

No AccessJournal of UrologyAdult urology1 Oct 2006The Effects of Adjusting for Case Mix on Mortality and Length of Stay Following Radical Cystectomy Brent K. Hollenbeck, David C. Miller, David A. Taub, Rodney L. Dunn, Shukri F. Khuri, William G. Henderson, James E. Montie, Willie Underwood, and John T. Wei Brent K. HollenbeckBrent K. Hollenbeck Department of Urology, University of Michigan, Ann Arbor, Michigan , David C. MillerDavid C. Miller Department of Urology, University of Michigan, Ann Arbor, Michigan , David A. TaubDavid A. Taub Department of Urology, University of Michigan, Ann Arbor, Michigan , Rodney L. DunnRodney L. Dunn Department of Urology, University of Michigan, Ann Arbor, Michigan , Shukri F. KhuriShukri F. Khuri National Surgical Quality Improvement Program, West Roxbury, Massachusetts , William G. HendersonWilliam G. Henderson National Surgical Quality Improvement Program, West Roxbury, Massachusetts , James E. MontieJames E. Montie Department of Urology, University of Michigan, Ann Arbor, Michigan , Willie UnderwoodWillie Underwood Department of Urology, University of Michigan, Ann Arbor, Michigan Veterans Affairs Medical Center, Ann Arbor, Michigan , and John T. WeiJohn T. Wei Department of Urology, University of Michigan, Ann Arbor, Michigan View All Author Informationhttps://doi.org/10.1016/j.juro.2006.06.015AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Prior studies evaluating quality of care following radical cystectomy have been constrained by the use of retrospective reviews of single institutional series and limited ability to examine risk factors in a comprehensive manner. Characterization of these factors could enhance preoperative patient counseling and facilitate perioperative management, thereby improving the quality of patient care. Materials and Methods: The National Surgical Quality Improvement Project is a prospective quality management initiative at 123 Veterans Affairs Medical Centers nationwide. The project collects preoperative clinical and intraoperative data, and outcomes on a wide variety of surgical procedures from multiple surgical disciplines. Since 1991, 2,538 radical cystectomies have been captured by the National Surgical Quality Improvement Project. Modeling using logistic regression was performed to identify preoperative risk factors associated with mortality and prolonged length of stay (greater than 90th percentile) after radical cystectomy. Results: The 30 and 90-day mortality rates following cystectomy were 2.9% and 6.8%, respectively, and median hospital stay was 11 days (90th percentile 30). Robust preoperative factors associated with mortality and prolonged length of stay that uniformly increased risk were older patient age (OR 1.2 to 1.4), American Society of Anesthesiologists class 3 or greater (OR 1.5 to 3.3), dependent functional status (OR 1.7 to 2.0) and low serum albumin (OR 2.1 to 12.0). Conclusions: A defined set of preoperative risk factors is independently associated with greater mortality and hospital stay following radical cystectomy. The breadth of these factors suggests that complex case mix adjustment is mandatory when comparing outcomes. Implementation of novel processes directed toward minimizing patient risk has the potential to improve outcomes following cystectomy. References 1 : High-risk surgery—follow the crowd. JAMA2000; 283: 1191. Google Scholar 2 : Hospital volume and surgical mortality in the United States. N Engl J Med2002; 346: 1128. Google Scholar 3 : Surgeon volume and operative mortality in the United States. N Engl J Med2003; 349: 2117. Google Scholar 4 : Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol2004; 22: 2781. Google Scholar 5 : Evaluating the quality of medical care. Milbank Memorial Fund Quart1966; vol. 44. Google Scholar 6 : Impact of a collaborative care approach to radical cystectomy and urinary reconstruction. J Urol1995; 154: 996. Link, Google Scholar 7 : The value of pathologic factors in predicting cancer-specific survival among patients treated with radical cystectomy for transitional cell carcinoma of the bladder and prostate. Cancer1993; 71: 3993. Crossref, Medline, Google Scholar 8 : The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg1995; 180: 519. Google Scholar 9 : Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg1997; 185: 328. Google Scholar 10 : Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg1997; 185: 315. Google Scholar 11 : A primer and comparative review of major US mortality databases. Ann Epidemiol2002; 12: 462. Google Scholar 12 : Causes of increased hospital stay after radical cystectomy in a clinical pathway setting. J Urol2002; 167: 208. Link, Google Scholar 13 : The changing pattern of mortality and morbidity from radical cystectomy. BJU Int2000; 85: 427. Google Scholar 14 : Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg2003; 238: 161. Google Scholar 15 : Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol2001; 19: 666. Crossref, Medline, Google Scholar 16 : A study of the morbidity, mortality and long-term survival following radical cystectomy and radical radiotherapy in the treatment of invasive bladder cancer in Yorkshire. Eur Urol2003; 43: 246. Google Scholar 17 : Complications of radical cystectomy and urinary diversion: a retrospective review of 675 cases in 2 decades. J Urol1992; 148: 1401. Link, Google Scholar 18 : Nutritional status of cancer patients and its relationship to function in an inpatient rehabilitation setting. Supportive Care Cancer2005; 13: 169. Google Scholar 19 : The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility. Ann Surg2002; 236:: 344. Google Scholar © 2006 by American Urological AssociationFiguresReferencesRelatedDetailsCited byFarag C, Akosman S, Luu J, Haji-Momenian S and Whalen M (2023) Hemoglobin, Albumin, Lymphocyte, and Platelet Count is a Significant Biomarker Surrogate for Nutritional Status to Predict Overall Survival in Patients Post–radical CystectomyUrology Practice, VOL. 10, NO. 3, (262-269), Online publication date: 1-May-2023.Mishra K, Ng M, Wang M, Mahran A, Callegari M, Sopko E, Ponsky L, Jankowski J and Bukavina L (2020) Direct Cost Savings Analysis of Nurse Practitioner for Inpatient Urology PracticeUrology Practice, VOL. 7, NO. 6, (467-473), Online publication date: 1-Nov-2020.Bhalla R, Wang L, Chang S and Tyson M (2017) Association between Preoperative Albumin Levels and Length of Stay after Radical CystectomyJournal of Urology, VOL. 198, NO. 5, (1039-1045), Online publication date: 1-Nov-2017.Tobert C, Hamilton-Reeves J, Norian L, Hung C, Brooks N, Holzbeierlein J, Downs T, Robertson D, Grossman R and Nepple K (2017) Emerging Impact of Malnutrition on Surgical Patients: Literature Review and Potential Implications for Cystectomy in Bladder CancerJournal of Urology, VOL. 198, NO. 3, (511-519), Online publication date: 1-Sep-2017.Ritch C, Cookson M, Chang S, Clark P, Resnick M, Penson D, Smith J, May A, Anderson C, You C, Lee H and Barocas D (2014) Impact of Complications and Hospital-Free Days on Health Related Quality of Life 1 Year after Radical CystectomyJournal of Urology, VOL. 192, NO. 5, (1360-1364), Online publication date: 1-Nov-2014.Boorjian S, Kim S, Tollefson M, Carrasco A, Cheville J, Thompson R, Thapa P and Frank I (2013) Comparative Performance of Comorbidity Indices for Estimating Perioperative and 5-Year All Cause Mortality Following Radical Cystectomy for Bladder CancerJournal of Urology, VOL. 190, NO. 1, (55-60), Online publication date: 1-Jul-2013.Jacobs B, Zhang Y, Tan H, Ye Z, Skolarus T and Hollenbeck B (2012) Hospitalization Trends After Prostate and Bladder Surgery: Implications of Potential Payment ReformsJournal of Urology, VOL. 189, NO. 1, (59-65), Online publication date: 1-Jan-2013.Morgan T, Keegan K, Barocas D, Ruhotina N, Phillips S, Chang S, Penson D, Clark P, Smith J and Cookson M (2011) Predicting the Probability of 90-Day Survival of Elderly Patients With Bladder Cancer Treated With Radical CystectomyJournal of Urology, VOL. 186, NO. 3, (829-834), Online publication date: 1-Sep-2011.Gregg J, Cookson M, Phillips S, Salem S, Chang S, Clark P, Davis R, Stimson C, Aghazadeh M, Smith J and Barocas D (2010) Effect of Preoperative Nutritional Deficiency on Mortality After Radical Cystectomy for Bladder CancerJournal of Urology, VOL. 185, NO. 1, (90-96), Online publication date: 1-Jan-2011.Aghazadeh M, Barocas D, Salem S, Clark P, Cookson M, Davis R, Gregg J, Stimson C, Smith J and Chang S (2010) Determining Factors for Hospital Discharge Status After Radical Cystectomy in a Large Contemporary CohortJournal of Urology, VOL. 185, NO. 1, (85-89), Online publication date: 1-Jan-2011.Stimson C, Chang S, Barocas D, Humphrey J, Patel S, Clark P, Smith J and Cookson M (2010) Early and Late Perioperative Outcomes Following Radical Cystectomy: 90-Day Readmissions, Morbidity and Mortality in a Contemporary SeriesJournal of Urology, VOL. 184, NO. 4, (1296-1300), Online publication date: 1-Oct-2010.Meng M (2008) Editorial CommentJournal of Urology, VOL. 180, NO. 1, (134-134), Online publication date: 1-Jul-2008. Volume 176Issue 4October 2006Page: 1363-1368 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordsbladder neoplasmscystectomymortalitybladderquality of health careMetrics Author Information Brent K. Hollenbeck Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author David C. Miller Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author David A. Taub Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Rodney L. Dunn Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Shukri F. Khuri National Surgical Quality Improvement Program, West Roxbury, Massachusetts More articles by this author William G. Henderson National Surgical Quality Improvement Program, West Roxbury, Massachusetts More articles by this author James E. Montie Department of Urology, University of Michigan, Ann Arbor, Michigan Financial interest and/or other relationship with AstraZeneca. More articles by this author Willie Underwood Department of Urology, University of Michigan, Ann Arbor, Michigan Veterans Affairs Medical Center, Ann Arbor, Michigan More articles by this author John T. Wei Department of Urology, University of Michigan, Ann Arbor, Michigan Financial interest and/or other relationship with Sanofi, Laserscope and Envisioneer. More articles by this author Expand All Advertisement PDF downloadLoading ...