Assessment of healthcare quality metrics: Length-of-stay, 30-day readmission, and 30-day mortality for radical nephrectomy with inferior vena cava thrombectomy

Authors

  • Y. Joseph Hwang 1. Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.
  • Brian J Minnillo 1. Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S. 2. Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.
  • Simon P Kim 1. Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S. 2. Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S. 3. Yale University, Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, New Haven, Connecticut, U.S.
  • Robert Abouassaly 1. Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S. 2. Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.

DOI:

https://doi.org/10.5489/cuaj.2547

Keywords:

length of stay, hospital readmission, mortality, nephrectomy, thrombectomy

Abstract

Introduction: Length-of-stay (LOS), 30-day readmission, and 30-day mortality are metrics used to assess quality of care and provider reimbursement. Therefore, we investigated patient- and hospital-level characteristics associated with the three healthcare quality metrics for radical nephrectomy with inferior vena cava (IVC) thrombectomy.

Methods: Using the National Cancer Data Base, we established a cohort of patients who received radical nephrectomy following the diagnosis of renal cell carcinoma (RCC) stage cT3b between 1998 and 2011. We then assessed the associations between patient- or hospital-level characteristics and LOS using multivariable negative binomial regression. We used multivariable logistic regression to determine the associations between the characteristics and 30-day readmission or 30-day mortality.

Results: During the study period, 5768 patients were diagnosed with RCC stage cT3b and underwent radical nephrectomy. LOS ≤2 days and ≥9 days were associated with a higher likelihood of 30-day readmission (respective odds ratio [OR] 1.61 and 1.58) and 30-day mortality (respective OR 11.62 and 11.87). Older patients (60–79 years vs. <50 years) were less likely to experience 30-day readmission (OR 0.46–0.52). Older patients (≥80 years vs. <50 years, OR 3.67) and patients with a high index of comorbidity (Charlson comorbidity score ≥ 2 vs. 0, OR 1.95) were more likely to suffer 30-day mortality.

Conclusions: LOS is an important predictor of short-term readmission and mortality following radical nephrectomy with IVC thrombectomy. Older age and a high index of comorbidity also predict short-term mortality after the surgery.

Downloads

Download data is not yet available.

Author Biographies

Y. Joseph Hwang, 1. Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.

MD Candidate, Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.

Brian J Minnillo, 1. Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S. 2. Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.

Urology resident, Department of Urology, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio, U.S.

Simon P Kim, 1. Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S. 2. Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S. 3. Yale University, Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, New Haven, Connecticut, U.S.

Assistant Professor, Department of Urology, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio, U.S.

Robert Abouassaly, 1. Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S. 2. Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.

Assistant Professor, Department of Urology, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio, U.S.

Downloads

Published

2015-04-13

How to Cite

Hwang, Y. J., Minnillo, B. J., Kim, S. P., & Abouassaly, R. (2015). Assessment of healthcare quality metrics: Length-of-stay, 30-day readmission, and 30-day mortality for radical nephrectomy with inferior vena cava thrombectomy. Canadian Urological Association Journal, 9(3-4), 114–21. https://doi.org/10.5489/cuaj.2547

Issue

Vol. 9 No. 3-4 (2015): CUAJ April

Section

Original Research

License

You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:

  • Post the Article on any Web site
  • Translate or authorize a translation of the Article
  • Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
  • Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.

The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.

You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.

The CUA also requires you to warrant the following:

  • That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
  • That all individuals who have made a substantive contribution to the article are acknowledged;
  • That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
  • That the Article does not libel or violate the privacy rights of any third party.