Open AccessImpact of academic affiliation on radical cystectomy outcomes in
Author(s) -
Marco Bianchi,
QuocDien Trinh,
Maxine Sun,
Malek Meskawi,
Jan Schmitges,
Shahrokh F. Shariat,
Alberto Briganti,
Zhe Tian,
Claudio Jeldres,
Shyam Sukumar,
James O. Peabody,
Markus Graefen,
Paul Perrotte,
Mani Me,
Francesco Montorsi,
Pierre I. Karakiewicz
Publication year - 2013
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.477
H-Index - 38
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.292
Subject(s) - medicine , cystectomy , logistic regression , comorbidity , odds ratio , odds , prospective cohort study , blood transfusion , emergency medicine , bladder cancer , cancer
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 NationwideInpatient 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 atacademic 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 complicationsand prolonged length of stay.