Florian Roghmann1, Praful Ravi2, Julian Hanske3, Christian P Meyer4, Mark A Preston4, Joachim Noldus1, Quoc-Dien Trinh4. 1. Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany; 2. The Royal London Hospital, Barts Health NHS Trust, London, UK; 3. Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA ; Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany; 4. Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Abstract
INTRODUCTION: In 1971, the National Cancer Institute (NCI) introduced a network of NCI-designated Cancer Centers (CC), which underwent a comprehensive approval process relying on research, education and prevention activities. In this study, we examine the effect of CC status on perioperative outcomes after radical cystectomy (RC). METHODS: Within the Nationwide Inpatient Sample, we focused on RC performed from 2006 to 2010. As all recognized centres were residency teaching institutions, we stratified according to teaching and CC-teaching status. We examined the rates of in-hospital mortality, intra- and postoperative complications, prolonged length of hospital stay, as well as blood transfusion. Multivariable logistic regression analyses were further adjusted for confounding factors. RESULTS: Overall, 22 840 RC patients (5451 at non-teaching, 10 857 at residency teaching, 6532 at CC-teaching institutions) were identified. Patients treated at residency teaching and CC-teaching institutions were younger, had less comorbidities, and more likely to have private insurance. In multivariable analyses, patients treated at residency and CC-teaching institutions were less likely to experience postoperative complications (odds ratio [OR] 0.73 and 0.66, respectively) and blood transfusions (OR 0.77 and 0.53, respectively) relative to patients treated at non-teaching institutions. In addition, CC patients were also less likely to experience in-hospital mortality (OR 0.61, all p < 0.001) as compared to non-teaching institutions. CONCLUSIONS: On average, patients treated at residency and CC-teaching institutions are less likely to experience unfavourable outcomes after RC. Moreover, patients treated at CC fared better than patients treated at residency teaching institutions. Our findings acknowledge the quality of RC care at accredited centres.
INTRODUCTION: In 1971, the National Cancer Institute (NCI) introduced a network of NCI-designated Cancer Centers (CC), which underwent a comprehensive approval process relying on research, education and prevention activities. In this study, we examine the effect of CC status on perioperative outcomes after radical cystectomy (RC). METHODS: Within the Nationwide Inpatient Sample, we focused on RC performed from 2006 to 2010. As all recognized centres were residency teaching institutions, we stratified according to teaching and CC-teaching status. We examined the rates of in-hospital mortality, intra- and postoperative complications, prolonged length of hospital stay, as well as blood transfusion. Multivariable logistic regression analyses were further adjusted for confounding factors. RESULTS: Overall, 22 840 RC patients (5451 at non-teaching, 10 857 at residency teaching, 6532 at CC-teaching institutions) were identified. Patients treated at residency teaching and CC-teaching institutions were younger, had less comorbidities, and more likely to have private insurance. In multivariable analyses, patients treated at residency and CC-teaching institutions were less likely to experience postoperative complications (odds ratio [OR] 0.73 and 0.66, respectively) and blood transfusions (OR 0.77 and 0.53, respectively) relative to patients treated at non-teaching institutions. In addition, CC patients were also less likely to experience in-hospital mortality (OR 0.61, all p < 0.001) as compared to non-teaching institutions. CONCLUSIONS: On average, patients treated at residency and CC-teaching institutions are less likely to experience unfavourable outcomes after RC. Moreover, patients treated at CC fared better than patients treated at residency teaching institutions. Our findings acknowledge the quality of RC care at accredited centres.
Authors: Quoc-Dien Trinh; Jan Schmitges; Maxine Sun; Shahrokh F Shariat; Shyam Sukumar; Marco Bianchi; Zhe Tian; Claudio Jeldres; Jesse Sammon; Paul Perrotte; Markus Graefen; James O Peabody; Mani Menon; Pierre I Karakiewicz Journal: J Urol Date: 2011-09-25 Impact factor: 7.450
Authors: Firas Abdollah; Maxine Sun; Jan Schmitges; Rodolphe Thuret; Orchidee Djahangirian; Claudio Jeldres; Zhe Tian; Shahrokh F Shariat; Paul Perrotte; Francesco Montorsi; Pierre I Karakiewicz Journal: Ann Surg Oncol Date: 2011-06-24 Impact factor: 5.344
Authors: Simon P Kim; Stephen A Boorjian; Nilay D Shah; R Jeffrey Karnes; Christopher J Weight; James P Moriarty; Matthew K Tollefson; Nathan D Shippee; Igor Frank Journal: BJU Int Date: 2012-03-22 Impact factor: 5.588
Authors: M Sun; F Abdollah; S F Shariat; J Schmitges; Q-D Trinh; Z Tian; C Jeldres; A Abdo; M Bianchi; A Briganti; F Montorsi; P Perrotte; P I Karakiewicz Journal: Eur J Surg Oncol Date: 2011-10-13 Impact factor: 4.424