Hiten D Patel1, Mark W Ball2, Jason E Cohen2, Max Kates2, Phillip M Pierorazio2, Mohamad E Allaf2. 1. James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: hitenpatel@jhmi.edu. 2. James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Abstract
OBJECTIVE: To quantify national complication rates, perioperative outcomes, and predictors for a broad range of urologic procedures to demonstrate background rates and discuss benchmarking. METHODS: Urologic procedures from the National Surgical Quality Improvement Program (2006-2011) were analyzed to identify 30-day rates of 21 complications; outcomes (length of stay, reoperation, and death); and predictors including resident involvement for 18 specific procedures. Multivariate logistic regression models assessed predictors for any complication and for Clavien grade IV or V complication. RESULTS: A total of 39,700 procedures were included with abdominopelvic operations more morbid than endoscopic, scrotal, incontinence, or prolapse procedures. Cystectomy had the highest morbidity (10.8 days length of stay and 3.2% mortality), with 56% experiencing any complication followed by nephrectomy (21%), retroperitoneal lymph node dissection (20%), and radical retropubic prostatectomy (19%). Transurethral resection of bladder tumor (11%) and transurethral resection of the prostate (10%) had the highest rates for endoscopic procedures. Older age, American Society of Anesthesiologists class, dependent functional status, acute kidney injury (odds ratio [OR], 2.70 [1.89-3.87]), and ≥5 units preoperative transfusion (OR, 4.44 [3.40-5.80]) were the strongest predictors of any complication. Higher ORs of similar predictors along with chronic obstructive pulmonary disorder (OR, 1.52 [1.21-1.92]) and steroid use (OR, 1.51 [1.07-2.14]) were associated with Clavien grade IV or V complication. Resident involvement increased odds of any complication (OR, 1.18 [1.09-1.29]), mostly for abdominopelvic and urogynecologic procedures, but not Clavien grade IV or V complication (P = .55). CONCLUSION: Complication rates of urologic procedures based on the retrospective experience of few surgeons do not allow for appropriate benchmarking. Baseline rates and benchmarks derived from the National Surgical Quality Improvement Program may help hospitals better track deficient areas and improvements in quality of care. Many predictors were similar across procedures, although magnitudes differed, and resident trainees did not impact rates of serious complications (Clavien-Dindo grade IV or V).
OBJECTIVE: To quantify national complication rates, perioperative outcomes, and predictors for a broad range of urologic procedures to demonstrate background rates and discuss benchmarking. METHODS: Urologic procedures from the National Surgical Quality Improvement Program (2006-2011) were analyzed to identify 30-day rates of 21 complications; outcomes (length of stay, reoperation, and death); and predictors including resident involvement for 18 specific procedures. Multivariate logistic regression models assessed predictors for any complication and for Clavien grade IV or V complication. RESULTS: A total of 39,700 procedures were included with abdominopelvic operations more morbid than endoscopic, scrotal, incontinence, or prolapse procedures. Cystectomy had the highest morbidity (10.8 days length of stay and 3.2% mortality), with 56% experiencing any complication followed by nephrectomy (21%), retroperitoneal lymph node dissection (20%), and radical retropubic prostatectomy (19%). Transurethral resection of bladder tumor (11%) and transurethral resection of the prostate (10%) had the highest rates for endoscopic procedures. Older age, American Society of Anesthesiologists class, dependent functional status, acute kidney injury (odds ratio [OR], 2.70 [1.89-3.87]), and ≥5 units preoperative transfusion (OR, 4.44 [3.40-5.80]) were the strongest predictors of any complication. Higher ORs of similar predictors along with chronic obstructive pulmonary disorder (OR, 1.52 [1.21-1.92]) and steroid use (OR, 1.51 [1.07-2.14]) were associated with Clavien grade IV or V complication. Resident involvement increased odds of any complication (OR, 1.18 [1.09-1.29]), mostly for abdominopelvic and urogynecologic procedures, but not Clavien grade IV or V complication (P = .55). CONCLUSION: Complication rates of urologic procedures based on the retrospective experience of few surgeons do not allow for appropriate benchmarking. Baseline rates and benchmarks derived from the National Surgical Quality Improvement Program may help hospitals better track deficient areas and improvements in quality of care. Many predictors were similar across procedures, although magnitudes differed, and resident trainees did not impact rates of serious complications (Clavien-Dindo grade IV or V).
Authors: Peter J Pronovost; David A Thompson; Christine G Holzmueller; Lisa H Lubomski; Laura L Morlock Journal: Crit Care Clin Date: 2005-01 Impact factor: 3.598
Authors: Yun Wang; Noel Eldridge; Mark L Metersky; Nancy R Verzier; Thomas P Meehan; Michelle M Pandolfi; JoAnne M Foody; Shih-Yieh Ho; Deron Galusha; Rebecca E Kliman; Nancy Sonnenfeld; Harlan M Krumholz; James Battles Journal: N Engl J Med Date: 2014-01-23 Impact factor: 91.245
Authors: Brent K Hollenbeck; David C Miller; David Taub; Rodney L Dunn; Shukri F Khuri; William G Henderson; James E Montie; Willie Underwood; John T Wei Journal: Cancer Date: 2006-04-01 Impact factor: 6.860
Authors: Brendan Wallace; Rodney H Breau; Sonya Cnossen; Christopher Knee; Daniel Mcisaac; Ranjeeta Mallick; Ilias Cagiannos; Christopher Morash; Luke T Lavallée Journal: Can Urol Assoc J Date: 2018-04-06 Impact factor: 1.862
Authors: Emily A Slopnick; Adonis K Hijaz; J Welles Henderson; Sangeeta T Mahajan; Carvell T Nguyen; Simon P Kim Journal: Int Urogynecol J Date: 2018-02-20 Impact factor: 2.894
Authors: Julie Y An; Mark W Ball; Michael A Gorin; Jiwon J Hong; Michael H Johnson; Christian P Pavlovich; Mohamad E Allaf; Phillip M Pierorazio Journal: Urology Date: 2016-11-23 Impact factor: 2.649
Authors: Meera R Chappidi; Heather J Chalfin; Daniel J Johnson; Max Kates; Nikolai A Sopko; Michael H Johnson; Jen-Jane Liu; Steven M Frank; Trinity J Bivalacqua Journal: Urol Oncol Date: 2016-10-19 Impact factor: 3.498
Authors: Meera R Chappidi; Max Kates; Hiten D Patel; Jeffrey J Tosoian; Deborah R Kaye; Nikolai A Sopko; Danny Lascano; Jen-Jane Liu; James McKiernan; Trinity J Bivalacqua Journal: Urol Oncol Date: 2016-02-15 Impact factor: 3.498
Authors: Ravi M Kumar; Luke T Lavallée; Darren Desantis; Sonya Cnossen; Ranjeeta Mallick; Ilias Cagiannos; Chris Morash; Rodney H Breau Journal: Can Urol Assoc J Date: 2017-06 Impact factor: 1.862
Authors: Katie S Murray; Megan Prunty; Alex Henderson; Tyler Haden; Naveen Pokala; Bin Ge; Mark Wakefield; Gregory F Petroski; David R Mehr; Robin L Kruse Journal: Urology Date: 2018-08-01 Impact factor: 2.649