Major Urologic Cancer Surgery Research Articles

Hospital re-admission patterns and outcomes following major urologic cancer surgery.

497 Background: Peri-operative morbidity and mortality varies considerably among hospitals. Given the highly complex surgery required for urologic cancer, post-operative adverse event management may be superior if treated in the same institution as the index surgery. Methods: We accessed the Washington State Comprehensive Hospital Abstract Reporting System from 2009-2013 to identified patients who underwent radical nephrectomy (RN), partial nephrectomy (PN), radical cystectomy (RC) or retroperitoneal lymph node dissection (RPLND) for malignant disease. Mortality rates were assessed in those with an adverse outcome requiring hospital re-admission within 90 days of surgery. The primary hospital (PH) was the institution where the main surgery took place. Secondary hospitals (SH) were all other hospitals. Relationships with mortality were examined using multi-variate modeling. Results: 4,542 patients were identified who underwent major urologic cancer surgery, of which 56% were RN, 26% PN, 15% RC and 2% RPLND. Overall, 795 (18%) experienced an adverse event following surgery requiring hospital admission. 64% of patients returned to their PH for management, but was dependent on the surgery performed (60% RN, 65% PN, 67% RC and 83% RPLND). When stratified by hospital volume, patients were more likely to present to their PH (p=0.0005), with more patients returning to their PH if it was a low vs. high volume center (72% vs 55%). Comorbidities and length of stay on index surgical admission did not affect whether patients chose to present to their PH or a SH for adverse event management. The overall mortality rate was 5%. On multi-variate analysis, patients who underwent surgery at a high-volume PH and presented to a SH for adverse event management had higher rates of mortality (p=0.03). Conclusions: Adverse events within 90 days of surgery of major urologic cancer surgery are associated with a low mortality rate, and most patients present to their PH for management. However, patients presenting to a SH experienced a higher mortality rate following an adverse event. These findings require further investigation and may aid in future quality improvement initiatives to reduce the morbidity associated with these complex surgeries.

Mortality after major surgery for urologic cancers in specialized urology hospitals: are they any better?: Konety BR, Allareddy V, Modak S, Smith B, Department of Urology, Carver College of Medicine and College of Public Health, University of Iowa, Iowa City, IA

Specialty-specific hospitals and hospitals with a high volume of complex procedures have been shown to have better outcomes. We sought to determine whether a high volume of unrelated complex procedures or procedures in the same specialty area (urology) could translate into better outcomes after major urologic cancer surgery. We performed a cross-sectional analysis of administrative discharge abstract data from the Nationwide Inpatient Sample of the Health Care Utilization Project for years 1998 to 2002. Comparison of outcome after three major urologic cancer-related surgical procedures (radical cystectomy [RC], radical nephrectomy [RN], and radical prostatectomy [RP]) at hospitals by procedure-specific volume, specialized urology status, and Leapfrog criteria was obtained to determine in-hospital mortality after the procedure. All patients in the database with a diagnosis of bladder, kidney, or prostate cancer being admitted for RC, RN, or RP between 1998 and 2002 were included. Neither specialized urology status nor meeting Leapfrog volume criteria for unrelated procedures was associated with lower odds of in-hospital mortality after any of the procedures examined. High-volume hospitals (for RC and RP) and moderate-volume hospitals (for RP) were associated with lower odds of mortality. None of the examined hospital volume-related factors was associated with lower odds of mortality after RN. In-hospital mortality after two of three major urologic cancer procedures is affected only by procedure-specific volumes. Generalized process measures existing in hospitals performing a high volume of general urologic procedures or unrelated complex procedures may be less important determinants of procedure-specific outcomes in patients.

Mortality After Major Surgery for Urologic Cancers in Specialized Urology Hospitals: Are They Any Better?

Specialty-specific hospitals and hospitals with a high volume of complex procedures have been shown to have better outcomes. We sought to determine whether a high volume of unrelated complex procedures or procedures in the same specialty area (urology) could translate into better outcomes after major urologic cancer surgery. We performed a cross-sectional analysis of administrative discharge abstract data from the Nationwide Inpatient Sample of the Health Care Utilization Project for years 1998 to 2002. Comparison of outcome after three major urologic cancer-related surgical procedures (radical cystectomy [RC], radical nephrectomy [RN], and radical prostatectomy [RP]) at hospitals by procedure-specific volume, specialized urology status, and Leapfrog criteria was obtained to determine in-hospital mortality after the procedure. All patients in the database with a diagnosis of bladder, kidney, or prostate cancer being admitted for RC, RN, or RP between 1998 and 2002 were included. Neither specialized urology status nor meeting Leapfrog volume criteria for unrelated procedures was associated with lower odds of in-hospital mortality after any of the procedures examined. High-volume hospitals (for RC and RP) and moderate-volume hospitals (for RP) were associated with lower odds of mortality. None of the examined hospital volume-related factors was associated with lower odds of mortality after RN. In-hospital mortality after two of three major urologic cancer procedures is affected only by procedure-specific volumes. Generalized process measures existing in hospitals performing a high volume of general urologic procedures or unrelated complex procedures may be less important determinants of procedure-specific outcomes in patients.

Use of predeposit autologous blood and intraoperative autotransfusion in urologic cancer surgery

A total of 20 patients underwent major urologic cancer surgery with the combined use of predeposit autologous blood and intraoperative autotransfusion with the Haemonetics Cell Saver. The estimated blood loss ranged from 400 to 2,000 mL (mean 1,208 mL). Total transfusion requirements for the 20 patients were 85.5 units of which 82.5 (96 %) were autologous. Predeposit autologous blood accounted for 53 percent, intraoperative autotransfusion blood 43 percent, and homologous blood 4 percent of the total transfusion requirements Of the 20 patients in the study, only 1 received homologous blood. There were no complications related to either modality of autotransfusion. Our data suggest that using the combined modalities of predeposit autologous blood donation and intraoperative autotransfusion, major urologic cancer surgery can be performed without homologous blood in most cases.