PD02-10 THE IMPACT OF SURGEON AND HOSPITAL VOLUME ON 30-DAY OUTCOMES AND COST FOR RENAL CANCER SURGERY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I (PD02)1 Apr 2020PD02-10 THE IMPACT OF SURGEON AND HOSPITAL VOLUME ON 30-DAY OUTCOMES AND COST FOR RENAL CANCER SURGERY Julia Wainger*, Joseph Cheaib, Hiten Patel, Mitchell Huang, Michael Biles, Michael Johnson, Joseph Canner, Mohamad Allaf, and Phillip Pierorazio Julia Wainger*Julia Wainger* More articles by this author , Joseph CheaibJoseph Cheaib More articles by this author , Hiten PatelHiten Patel More articles by this author , Mitchell HuangMitchell Huang More articles by this author , Michael BilesMichael Biles More articles by this author , Michael JohnsonMichael Johnson More articles by this author , Joseph CannerJoseph Canner More articles by this author , Mohamad AllafMohamad Allaf More articles by this author , and Phillip PierorazioPhillip Pierorazio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000822.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Provider and hospital factors influence quality, but granular data is lacking to assess their impact on renal cancer surgery. The Maryland Health Service Cost Review Commission (HSCRC) is an independent state agency that promotes cost containment, access to care and accountability. Within HSCRC, we aimed to assess the impact of surgeon and hospital volume on 30-day outcomes after renal cancer surgery. METHODS: Data on renal surgery were abstracted from the Maryland HSCRC from 2000-2018. We excluded patients younger than 18, patients without a diagnosis of renal cancer, and patients concurrently receiving another major surgery. Volume categories were derived from the distribution of mean cases performed per year. We used adjusted multivariable logistic and linear regression models to identify associations of surgeon and hospital volume with length of stay, days in intensive care, cost, 30-day mortality, readmission, and complications. RESULTS: A total of 10,590 surgeries, completed by 669 surgeons at 48 hospitals, met criteria. The 25th percentile for cases per year was 1, the 50th percentile was 1.2, and the 75th percentile was 2.6. After adjusting for patient factors and cumulative surgeon experience, high volume surgeons had the greatest decrease in length of stay and mortality risk compared to rare volume surgeons. Low volume surgeons had the greatest cost decrease (Table 1). Medium volume hospitals had statistically significant lower average costs than rare volume hospitals (Table 2). There were no other clinically and statistically significant relationships between volume and measured outcomes. CONCLUSIONS: Almost half of the urologists studied performed an average of one renal cancer case per year. Greater surgeon volume was associated with shorter length of stay and decreased mortality risk. Hospital volume did not have a meaningful relationship to outcomes. Other factors such as tumor, surgeon, and hospital characteristics or case mix may associate with outcomes and could be confounders. Source of Funding: Funding for the Predoctoral Clinical Research Training Program is provided by the Johns Hopkins School of Medicine, Bloomberg School of Public Health, and Johns Hopkins Institute for Clinical and Translational Research (ICTR) by way of a Clinical and Translational Science Award (CTSA) from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e70-e70 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julia Wainger* More articles by this author Joseph Cheaib More articles by this author Hiten Patel More articles by this author Mitchell Huang More articles by this author Michael Biles More articles by this author Michael Johnson More articles by this author Joseph Canner More articles by this author Mohamad Allaf More articles by this author Phillip Pierorazio More articles by this author Expand All Advertisement PDF downloadLoading ...