Impact of academic affiliation on radical cystectomy outcomes in

Authors

  • Marco Bianchi Department of Urology, Vita-Salute University, Urological Research Institute, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
  • Quoc-Dien Trinh Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC; Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
  • Maxine Sun Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
  • Malek Meskawi Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
  • Jan Schmitges Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
  • Shahrokh F. Shariat Department of Urology, Weill Medical College of Cornell University, New York, NY
  • Alberto Briganti Department of Urology, Vita-Salute University, Urological Research Institute, Milan, Italy
  • Zhe Tian Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
  • Claudio Jeldres Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
  • Shyam Sukumar Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
  • James O. Peabody Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
  • Markus Graefen Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  • Paul Perrotte Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
  • Mani Menon Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
  • Francesco Montorsi Department of Urology, Vita-Salute University, Urological Research Institute, Milan, Italy
  • Pierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC

DOI:

https://doi.org/10.5489/cuaj.292

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, stratified according to institutional academic status in patients undergoing 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. Multivariable logistic regression analyses were fitted to predict the likelihood of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, and in-hospital mortality. Covariates included age, race, gender, Charlson Comorbidity Index (CCI), 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 academic institutions were younger and healthier at baseline (all p < 0.001). RCs performed at academic institutions were associated 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 academic 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 outcomes 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 complications
and prolonged length of stay.

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Published

2013-02-21

How to Cite

Bianchi, M., Trinh, Q.-D., Sun, M., Meskawi, M., Schmitges, J., Shariat, S. F., Briganti, A., Tian, Z., Jeldres, C., Sukumar, S., Peabody, J. O., Graefen, M., Perrotte, P., Menon, M., Montorsi, F., & Karakiewicz, P. I. (2013). Impact of academic affiliation on radical cystectomy outcomes in. Canadian Urological Association Journal, 6(4), 245–50. https://doi.org/10.5489/cuaj.292

Issue

Vol. 6 No. 4 (2012): CUAJ August

Section

Original Research

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