Hospital-level Variation in the Quality of Benign Inpatient Urologic Surgery

Hilary Zetlen; Kenn B Daratha; Jonathan D Harper; Hunter Wessells; Kenneth P Roberts; John L Gore

doi:10.1016/j.urology.2015.07.067

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Hospital-level Variation in the Quality of Benign Inpatient Urologic Surgery

Journal article

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Peer reviewed

Hospital-level Variation in the Quality of Benign Inpatient Urologic Surgery

Hilary Zetlen, Kenn B Daratha, Jonathan D Harper, Hunter Wessells, Kenneth P Roberts and John L Gore

Urology (Ridgewood, N.J.), Vol.87, pp.82-87

01/2016

DOI: https://doi.org/10.1016/j.urology.2015.07.067

Handle:

https://hdl.handle.net/2376/115940

PMCID: PMC5861261

PMID: 26519000

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Abstract

Humans

Middle Aged

Quality Indicators, Health Care

Male

Treatment Outcome

Transurethral Resection of Prostate - standards

Washington

Prostatic Hyperplasia - surgery

Inpatients

Hospitals

Length of Stay - trends

Aged

Retrospective Studies

To examine hospital-level variation in outcomes following benign urologic surgeries given that hospital-level variation in surgical outcomes can portend quality and appropriateness of care concerns and identify quality improvement opportunities in perioperative care. Using the Washington State Comprehensive Hospital Abstract Reporting System, we identified patients who underwent transurethral resection of the prostate (TURP), percutaneous nephrostolithotomy (PCNL), and pyeloplasty from 2003 to 2008. We classified prolonged postoperative length of stay (LOS) as that exceeding the 75th percentile, and we measured the rate of Agency for Healthcare Quality Patient Safety Indicators, readmissions, and death. We calculated hospital-specific observed-to-expected event rates using random effects multilevel multivariable models adjusted for age and comorbidity. We identified 6699 TURP patients at 54 hospitals, 2541 PCNL patients at 45 hospitals, and 584 pyeloplasty patients at 36 hospitals. Complication rates were highest after PCNL (22.9% prolonged LOS vs 17.3% for TURP and 13.9% for pyeloplasty, P < .001; 3.4% 90-day mortality vs 0.6% for TURP and 0% for pyeloplasty). Hospital-level variation was most substantial for LOS after TURP and pyeloplasty (8.1% and 14.3% of variance in prolonged LOS, respectively). Hospital-level variation is common after benign inpatient urologic surgeries and may relate to difference in perioperative provider practice patterns. The morbidity of PCNL in this study was higher than expected and merits further investigation.

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Title: Hospital-level Variation in the Quality of Benign Inpatient Urologic Surgery
Creators: Hilary Zetlen - Department of Urology, University of Washington School of Medicine, Seattle, WA
Kenn B Daratha - College of Nursing, Washington State University, Spokane, WA
Jonathan D Harper - Department of Urology, University of Washington School of Medicine, Seattle, WA
Hunter Wessells - Department of Urology, University of Washington School of Medicine, Seattle, WA
Kenneth P Roberts - College of Medical Sciences, Washington State University, Spokane, WA
John L Gore - Department of Urology, University of Washington School of Medicine, Seattle, WA. Electronic address: jlgore@u.washington.edu
Publication Details: Urology (Ridgewood, N.J.), Vol.87, pp.82-87
Publisher: United States
Grant note: UL1RR025014 / NCRR NIH HHS UL1 RR025014 / NCRR NIH HHS UL1 TR002319 / NCATS NIH HHS
Identifiers: 99900547628501842
Language: English
Resource Type: Journal article