MP54-10 ANALYSIS OF QUALITY INDICATORS FOR CYSTECTOMY USING DATA FROM THE NATIONAL CANCER DATABASE

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2017MP54-10 ANALYSIS OF QUALITY INDICATORS FOR CYSTECTOMY USING DATA FROM THE NATIONAL CANCER DATABASE Andrew Bachman, Alexander Parker, Marshall Shaw, Brian Cross, Kelly Stratton, Michael Cookson, and Sanjay Patel Andrew BachmanAndrew Bachman More articles by this author , Alexander ParkerAlexander Parker More articles by this author , Marshall ShawMarshall Shaw More articles by this author , Brian CrossBrian Cross More articles by this author , Kelly StrattonKelly Stratton More articles by this author , Michael CooksonMichael Cookson More articles by this author , and Sanjay PatelSanjay Patel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1682AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To examine the national patterns of quality indicators for cystectomy and identify facility characteristics predictive of high quality care. METHODS We performed a retrospective cohort study of patients who underwent cystectomy for cT2-cT4, N0 bladder cancer between 2008 and 2013 using the National Cancer Database. Quality indicators were defined as 1) surgical margin status, 2) lymph node yield, and 3) receipt of neoadjuvant chemotherapy. Univariate analysis and multivariate analysis was used to assess the relationship between academic facility type and annual cystectomy volume and quality indicators while controlling for demographic and pathologic characteristics. RESULTS A total of 12,083 patients met our inclusion criteria. On multivariate analysis, while controlling for demographic and pathologic characteristics, treatment at academic facilities was associated with higher rates of negative margins (OR: 0.80; 95%CI: [0.67-0.95], p=0.01), greater lymph node yields (OR: 0.49; [0.44-0.55], p<0.001), and higher rates of neoadjuvant chemotherapy(OR: 0.73; [0.64-0.55], p<0.001). High volume facilities (>24 cystectomies/year) were associated with greater lymph node yields (OR: 2.69; [2.08-3.47], p<0.001), but not significantly associated with increased neoadjuvant chemotherapy use. Intermediate volume centers (12-24 cystectomies/year) were associated with increased neoadjuvant chemotherapy use (OR: 1.60; [1.36-1.88], p<0.001). CONCLUSIONS At a national level, high quality indicators of cystectomy (negative surgical margin, adequate lymph node yields, and receipt of neoadjuvant chemotherapy) were more likely to occur at academic facilities. High volume centers were associated with higher lymph node yields. Such data support the regionalization of cystectomy care to these centers. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e725-e726 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Andrew Bachman More articles by this author Alexander Parker More articles by this author Marshall Shaw More articles by this author Brian Cross More articles by this author Kelly Stratton More articles by this author Michael Cookson More articles by this author Sanjay Patel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...