PD38-12 THE EFFECT OF HOSPITAL AND PROVIDER VOLUME ON READMISSIONS, MORTALITY AND LENGTH OF STAY FOR RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V1 Apr 2018PD38-12 THE EFFECT OF HOSPITAL AND PROVIDER VOLUME ON READMISSIONS, MORTALITY AND LENGTH OF STAY FOR RADICAL PROSTATECTOMY Mark Finkelstein and Michael Palese Mark FinkelsteinMark Finkelstein More articles by this author and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1759AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES An emerging body of literature has established a relationship between case volume and outcomes after radical prostatectomy (RP). The purpose of this study was to expand on this body of knowledge by analyzing a larger breadth of outcomes while factoring hospital, provider, and patient-level variables. METHODS Patients who underwent RP between 2009 and 2014 were identified using ICD-9-CM codes from the Statewide Planning and Research Cooperative System database, a comprehensive all-payer reporting system that contains all hospital discharges in New York State. Data was supplemented with facility-level information from the American Hospital Association, provider-level information from the American Medical Association Masterfile, and additional information from US Census data. Multivariable regression was used to assess the effect of hospital and physician volume, while adjusting for patient and hospital characteristics. RESULTS 25,550 encounters involving RP were identified from 2009 to 2014 of which 25,425 could be matched to a urologist and were used during the course of this study. These encounters occurred at 122 different facilities under the supervision of 388 surgeons. Of the total considered, 1,329 (5.2%) were readmitted within 90 days, 107 (0.4%) died within a year, and the median total charge was $27,216 (IQR; $21,302:$35,333). Every two-fold increase in physician caseload was associated with a 5% decrease 90-day readmission (OR 0.95 [0.92, 0.98]), 20% decrease in prolonged stay (OR 0.80 [0.78, 0.82]), no significant change in 1-year mortality rate (OR 0.91 [0.81, 1.02]), and a 7% decline in total charge (OR -0.07 [-0.08,-0.06]). Every two-fold increase in facility caseload was associated with no significant change in 90-day readmission (OR 1.03 [0.99, 1.07]), 19% decrease in prolonged stay (OR 0.81 [0.79, 0.83]), no significant change in 1-year mortality rate (OR 0.98 [0.86, 1.11]), and a 6% increase in total charge (0.06 [0.05, 0.07]). CONCLUSIONS This study demonstrated that increasing physician caseload in RP is associated with benefits in decreasing rates of 90-day readmission and prolonged stay as well as lowering associated total charges. Increasing facility volume was associated with decreases in rates of prolonged stay, but increases in associated total charges. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e741 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mark Finkelstein More articles by this author Michael Palese More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...