Christian P Meyer1, Michael Hollis2, Alexander P Cole3, Julian Hanske4, James O'Leary3, Soham Gupta3, Björn Löppenberg4, Mike E Zavaski3, Maxine Sun3, Jesse D Sammon3, Adam S Kibel3, Margit Fisch3, Felix K H Chun3, Quoc-Dien Trinh5. 1. Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Pediatric Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. 3. Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 4. Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany. 5. Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: trinh.qd@gmail.com.
Abstract
BACKGROUND: Measuring procedure-specific complication-rate trends allows for benchmarking and improvement in quality of care but must be done in a standardized fashion. DESIGN, SETTING, AND PARTICIPANTS: Using the Nationwide Inpatient Sample, we identified all instances of eight common inpatient urologic procedures performed in the United States between 2000 and 2010. This yielded 327218 cases including both oncologic and benign diseases. Complications were identified by International Classification of Diseases, Ninth Revision codes. Each complication was cross-referenced to the procedure code and graded according to the standardized Clavien system. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The Mann-Whitney and chi-square were used to assess the statistical significance of medians and proportions, respectively. We assessed temporal variability in the rates of overall complications (Clavien grade 1-4), length of hospital stay, and in-hospital mortality using the estimated annual percent change (EAPC) linear regression methodology. RESULTS AND LIMITATIONS: We observed an overall reduction in length of stay (EAPC: -1.59; p<0.001), whereas mortality rates remained negligible and unchanged (EAPC: -0.32; p=0.83). Patient comorbidities increased significantly over the study period (EAPC: 2.09; p<0.001), as did the rates of complications. Procedure-specific trends showed a significant increase in complications for inpatient ureterorenoscopy (EAPC: 5.53; p<0.001), percutaneous nephrolithotomy (EAPC: 3.75; p<0.001), radical cystectomy (EAPC: 1.37; p<0.001), radical nephrectomy (EAPC: 1.35; p<0.001), and partial nephrectomy (EAPC: 1.22; p=0.006). Limitations include lack of postdischarge follow-up data, lack of pathologic characteristics, and inability to adjust for secular changes in administrative coding. CONCLUSIONS: In the context of urologic care in the United States, our findings suggest a shift toward more complex oncologic procedures in the inpatient setting, with same-day procedures most likely shifted to the outpatient setting. Consequently, complications have increased for the majority of examined procedures; however, no change in mortality was found. PATIENT SUMMARY: This report evaluated the trends of urologic procedures and their complications. A significant shift toward sicker patients and more complex procedures in the inpatient setting was found, but this did not result in higher mortality. These results are indicators of the high quality of care for urologic procedures in the inpatient setting.
BACKGROUND: Measuring procedure-specific complication-rate trends allows for benchmarking and improvement in quality of care but must be done in a standardized fashion. DESIGN, SETTING, AND PARTICIPANTS: Using the Nationwide Inpatient Sample, we identified all instances of eight common inpatient urologic procedures performed in the United States between 2000 and 2010. This yielded 327218 cases including both oncologic and benign diseases. Complications were identified by International Classification of Diseases, Ninth Revision codes. Each complication was cross-referenced to the procedure code and graded according to the standardized Clavien system. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The Mann-Whitney and chi-square were used to assess the statistical significance of medians and proportions, respectively. We assessed temporal variability in the rates of overall complications (Clavien grade 1-4), length of hospital stay, and in-hospital mortality using the estimated annual percent change (EAPC) linear regression methodology. RESULTS AND LIMITATIONS: We observed an overall reduction in length of stay (EAPC: -1.59; p<0.001), whereas mortality rates remained negligible and unchanged (EAPC: -0.32; p=0.83). Patient comorbidities increased significantly over the study period (EAPC: 2.09; p<0.001), as did the rates of complications. Procedure-specific trends showed a significant increase in complications for inpatient ureterorenoscopy (EAPC: 5.53; p<0.001), percutaneous nephrolithotomy (EAPC: 3.75; p<0.001), radical cystectomy (EAPC: 1.37; p<0.001), radical nephrectomy (EAPC: 1.35; p<0.001), and partial nephrectomy (EAPC: 1.22; p=0.006). Limitations include lack of postdischarge follow-up data, lack of pathologic characteristics, and inability to adjust for secular changes in administrative coding. CONCLUSIONS: In the context of urologic care in the United States, our findings suggest a shift toward more complex oncologic procedures in the inpatient setting, with same-day procedures most likely shifted to the outpatient setting. Consequently, complications have increased for the majority of examined procedures; however, no change in mortality was found. PATIENT SUMMARY: This report evaluated the trends of urologic procedures and their complications. A significant shift toward sicker patients and more complex procedures in the inpatient setting was found, but this did not result in higher mortality. These results are indicators of the high quality of care for urologic procedures in the inpatient setting.
Authors: Hendrik Borgmann; Mohamed M Kamal; Anna Metzger; Robert Dotzauer; Nikita Fischer; Peter Sparwasser; Wolfgang Jäger; Igor Tsaur; Axel Haferkamp; Thomas Höfner Journal: J Clin Med Date: 2022-02-22 Impact factor: 4.241
Authors: Andrea M Simi; Graham C Chapman; Jacqueline Zillioux; Sarah Martin; Emily A Slopnick Journal: Neurourol Urodyn Date: 2022-03-29 Impact factor: 2.367