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- Title
Impact of academic affiliation on radical cystectomy outcomes in North America: A population-based study.
- Authors
Bianchi, Marco; Trinh, Quoc-Dien; Sun, Maxine; Meskawi, Malek; Schmitges, Jan; Shariat, Shahrokh F.; Briganti, Alberto; Zhe Tian; Jeldres, Claudio; Sukumar, Shyam; Peabody, James 0.; Graefen, Markus; Perrotte, Paul; Menon, Mani; Montorsi, Francesco; Karakiewicz, Pierre I.
- Abstract
Background: The objective of this study was to examine the rates of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, as well as in-hospital mortality, strati-fied according to institutional academic status in patients undergo-ing radical cystectomy (RC). Methods: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on patients in whom RC was performed between 1998 and 2007. Multivariate logistic regres-sion analyses were fitted to predict the likelihood of blood transfu-sions, prolonged length of stay, intraoperative and postoperative complications, and in-hospital mortality. Covariates included age, race, gender, Charlson Comorbidity Index (CCD, hospital region, insurance status, annual hospital caseload (AHC), year of surgery and urinary diversion. Results: Overall, 12 262 patients underwent RC. Of those, 7892 (64.4%) were from academic institutions. Patients treated at aca-demic institutions were younger and healthier at baseline (all p < 0.001). RCs performed at academic institutions were associ-ated with fewer postoperative complications (28.8% vs. 32.9%, p < 0.001), shorter length of stay (54.0% vs. 56.2%, p = 0.02) and lower in-hospital mortality rates (2.1 vs. 3.0%, p = 0.002). In multivariable analyses, patients who underwent RC at an aca-demic hospital were 12% less likely to succumb to postoperative complications (odds ratio=0.88, p = 0.003). Interpretation: Even after adjusting for AHC, RCs performed at academic institutions are associated with better postoperative out-comes than RCs performed at non-academic institutions. From a public health prospective, performing RCs at academic institutions may help reduce costs associated with the management of com-plications and prolonged length of stay.
- Subjects
CYSTECTOMY; HEALTH outcome assessment; SURGICAL complications; UNIVERSITIES &; colleges; PUBLIC health; MEDICAL care
- Publication
Canadian Urological Association Journal, 2012, Vol 6, Issue 4, p245
- ISSN
1911-6470
- Publication type
Article
- DOI
10.5489/cuaj.12032