دورية أكاديمية
Teaching Hospitals and Textbook Outcomes After Major Urologic Cancer Surgery.
العنوان: | Teaching Hospitals and Textbook Outcomes After Major Urologic Cancer Surgery. |
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المؤلفون: | Dall CP; Department of Urology, Massachusetts General Hospital, Boston, MA; Department of Urology, Brigham and Women's Hospital, Boston, MA. Electronic address: Cdall@mgb.org., Liu X; Department of Urology, Massachusetts General Hospital, Boston, MA., Faraj KS; Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI., Srivastava A; Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI., Kaufman SR; Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI., Shahinian VB; Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI., Hollenbeck BK; Department of Urology, Massachusetts General Hospital, Boston, MA; Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI. |
المصدر: | Urology [Urology] 2024 Jun 13. Date of Electronic Publication: 2024 Jun 13. |
Publication Model: | Ahead of Print |
نوع المنشور: | Journal Article |
اللغة: | English |
بيانات الدورية: | Publisher: Elsevier Science Country of Publication: United States NLM ID: 0366151 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-9995 (Electronic) Linking ISSN: 00904295 NLM ISO Abbreviation: Urology Subsets: MEDLINE |
أسماء مطبوعة: | Publication: New York : Elsevier Science Original Publication: Ridgewood, N.J., Professional Medical Services Co. |
مستخلص: | Objective: To assess textbook outcomes by hospital teaching status following major surgery for urologic cancers. Methods: We used 100% national Medicare Provider Analysis and Review files from 2017-2020 to assess rates of textbook outcomes in patients undergoing bladder (ie, radical cystectomy), kidney (ie, radical or partial nephrectomy), and prostate (ie, radical prostatectomy) surgery for genitourinary malignancies. The extent of integration of learners into each hospital's workforce-defined as major, minor, and non teaching hospitals-was the primary exposure. A textbook outcome, measured at the patient level, was defined as the absence of in-hospital mortality and mortality within 30days of surgery, no readmission 30days following discharge, no postoperative complication, and no prolonged length of stay. Results: Textbook outcomes were achieved in 51% (8564/16,786) of patients after bladder cancer surgery, 70% (39,938/57,300) of patients after kidney cancer surgery, and 82% (50,408/61,385) of patients after prostate cancer surgery. After adjusting for patient- and hospital-level characteristics, teaching hospitals had higher rates of textbook outcomes in those undergoing bladder (50.7% vs 44.0%; P = .001), kidney (72.0% vs 69.7%; P = .02), and prostate (85.3% vs 81.0%; P <.001) surgery. This effect was attenuated, but not eliminated, by surgical volume in additional sensitivity analyses for bladder (OR: 1.20, 95% CI: 1.00-1.42; P = .04) and prostate (OR: 1.15, 95% CI: 1.00-1.32; P = .04) surgery. There were no significant differences in kidney cancer surgery outcomes after adjusting for hospital volume (OR: 1.03, 95% CI: 0.93-1.14; P = .6). Conclusion: Undergoing major cancer surgery at a teaching hospital was associated with an increased likelihood of achieving a textbook outcome. This effect was attenuated by volume but persisted for bladder and prostate surgery. Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Copyright © 2024 Elsevier Inc. All rights reserved.) |
تواريخ الأحداث: | Date Created: 20240615 Latest Revision: 20240628 |
رمز التحديث: | 20240629 |
DOI: | 10.1016/j.urology.2024.06.007 |
PMID: | 38878826 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1527-9995 |
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DOI: | 10.1016/j.urology.2024.06.007 |