Perioperative outcomes after radical cystectomy at NCI-designated centres: Are they any better?

Authors

  • Florian Roghmann Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany shared first
  • Praful Ravi The Royal London Hospital, Barts Health NHS Trust, London, UK shared first
  • Julian Hanske Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
  • Christian P Meyer Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  • Mark A Preston Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  • Joachim Noldus Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
  • Quoc-Dien Trinh Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

DOI:

https://doi.org/10.5489/cuaj.2621

Keywords:

radical cystectomy, teaching status, cancer center, morbidity, complication

Abstract

Introduction: In 1971, the National Cancer Institute (NCI) introduced a network of NCI-designated Cancer Centers (CC), which underwent a comprehensive approval process relying on research, education and prevention activities. In this study, we examine the effect of CC status on perioperative outcomes after radical cystectomy (RC).

Methods: Within the Nationwide Inpatient Sample, we focused on RC performed from 2006 to 2010. As all recognized centres were residency teaching institutions, we stratified according to teaching and CC-teaching status. We examined the rates of in-hospital mortality, intra- and postoperative complications, prolonged length of hospital stay, as well as blood transfusion. Multivariable logistic regression analyses were further adjusted for confounding factors.

Results: Overall, 22 840 RC patients (5451 at non-teaching, 10 857 at residency teaching, 6532 at CC-teaching institutions) were identified. Patients treated at residency teaching and CC-teaching institutions were younger, had less comorbidities, and more likely to have private insurance. In multivariable analyses, patients treated at residency and CC-teaching institutions were less likely to experience postoperative complications (odds ratio [OR] 0.73 and 0.66, respectively) and blood transfusions (OR 0.77 and 0.53, respectively) relative to patients treated at non-teaching institutions. In addition, CC patients were also less likely to experience in-hospital mortality (OR 0.61, all p < 0.001) as compared to non-teaching institutions.

Conclusions: On average, patients treated at residency and CC-teaching institutions are less likely to experience unfavourable outcomes after RC. Moreover, patients treated at CC fared better than patients treated at residency teaching institutions. Our findings acknowledge the quality of RC care at accredited centres.

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Published

2015-06-15

How to Cite

Roghmann, F., Ravi, P., Hanske, J., Meyer, C. P., Preston, M. A., Noldus, J., & Trinh, Q.-D. (2015). Perioperative outcomes after radical cystectomy at NCI-designated centres: Are they any better?. Canadian Urological Association Journal, 9(5-6), 207–12. https://doi.org/10.5489/cuaj.2621

Issue

Section

Original Research