Hospital-level variation in the quality of urologic cancer surgery

John L Gore; Jonathan L Wright; Kenn B Daratha; Kenneth P Roberts; Daniel W Lin; Hunter Wessells; Michael Porter

doi:10.1002/cncr.26373

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Hospital-level variation in the quality of urologic cancer surgery

Journal article

Open access

Peer reviewed

Hospital-level variation in the quality of urologic cancer surgery

John L Gore, Jonathan L Wright, Kenn B Daratha, Kenneth P Roberts, Daniel W Lin, Hunter Wessells and Michael Porter

Cancer, Vol.118(4), pp.987-996

02/15/2012

DOI: https://doi.org/10.1002/cncr.26373

Handle:

https://hdl.handle.net/2376/110421

PMCID: PMC3273633

PMID: 21792864

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https://doi.org/10.1002/cncr.26373View

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Abstract

Outcome Assessment (Health Care)

Humans

Middle Aged

Male

Washington

Young Adult

Kidney Neoplasms - surgery

Aged, 80 and over

Adult

Female

Quality of Health Care - standards

Retrospective Studies

Length of Stay

Prostatectomy - standards

Urinary Bladder Neoplasms - mortality

Prostatic Neoplasms - surgery

Kidney Neoplasms - mortality

Urinary Bladder Neoplasms - surgery

Prostatic Neoplasms - mortality

Nephrectomy - standards

Adolescent

Cystectomy - standards

Aged

Surgery Department, Hospital - standards

Cohort Studies

Unexplained variation in outcomes after common surgeries raises concerns about the quality and appropriateness of surgical care. Understanding variation in surgical outcomes may identify processes that could affect the quality of surgical and postoperative care. The authors of this report examined hospital-level variation in outcomes after inpatient urologic oncology procedures. Patients who underwent radical cystectomy, radical nephrectomy, and radical prostatectomy were identified from the Washington State Comprehensive Hospital Abstract Reporting System for the years 2003 through 2007. The postoperative length of stay (LOS) was measured, and LOS that exceeded the 75th percentile was classified as prolonged. The occurrence of Agency for Healthcare Quality patient safety indicators (PSIs), readmissions, and deaths also were measured. Analyses were adjusted for patient age and comorbidity in random effects, multilevel, multivariable models that assessed hospital-level outcomes. The authors identified 853 patients from 37 hospitals who underwent cystectomy, 3018 patients who underwent nephrectomy from 51 hospitals, and 8228 patients who underwent prostatectomy from 51 hospitals. Complications captured by PSIs were rare. Hospital-level variation was most profound for LOS outcomes after nephrectomy and prostatectomy (variance in prolonged LOS, 8.1% and 26.7%, respectively), thromboembolic events after nephrectomy (8% of variance), and mortality after cystectomy (7.1% of variance). Hospital-level variation confounds the care of urologic cancer patients in the state of Washington. The authors concluded that transparent reporting of surgical outcomes and local quality-improvement initiatives should be considered to ameliorate the observed variation and improve the quality of cystectomy, nephrectomy, and prostatectomy care.

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Title: Hospital-level variation in the quality of urologic cancer surgery
Creators: John L Gore - Department of Urology, University of Washington School of Medicine, Seattle, Washington 98195, USA. jlgore@u.washington.edu
Jonathan L Wright
Kenn B Daratha
Kenneth P Roberts
Daniel W Lin
Hunter Wessells
Michael Porter
Publication Details: Cancer, Vol.118(4), pp.987-996
Academic Unit: Elson S. Floyd College of Medicine
Publisher: United States
Grant note: UL1RR025014 / NCRR NIH HHS UL1 RR025014-05 / NCRR NIH HHS UL1 RR025014 / NCRR NIH HHS
Identifiers: 99900547244801842
Language: English
Resource Type: Journal article