Optimal Cystectomy Outcome: A Composite Measurement Evaluating Quality of Care and Mortality Benefit.

Abstract

OBJECTIVES:

To evaluate the incidence and impact of an "optimal cystectomy outcome" (OCO), a simplified performance metric that encompasses multiple patient-centered outcomes.

METHODS:

We identified patients in the National Cancer Center Database undergoing radical cystectomy for stage cT2-cT3 urothelial carcinoma (2006-2014). OCO was defined as negative resection margin, adequate lymphadenectomy (>10 nodes), no prolonged length-of-stay (<75th percentile), no 30-day-readmission, and no 30-day-mortality. We used multivariable logistic regression and Cox proportional-hazards models to identify factors associated with OCO and overall survival (OS).

RESULTS:

Among 12,997 patients who fit the inclusion criteria, individual OCO components were attained at a relatively high rate; however, only 37.6% of patients met all 5 OCO criteria. Patients who underwent surgery at a high-volume (OR 2.45) academic facility (OR 1.60) using a minimally-invasive approach (OR 1.32) were more likely to receive an OCO. Patients were less likely to receive an OCO if they were older (OR 0.98), African American (OR 0.71), had Medicaid insurance (OR 0.66), or more comorbidities (OR 0.48) (all P <0.05). Patients who received an OCO were found to have a significantly lower risk of overall mortality (HR 0.69, P <0.05).

CONCLUSION:

Various patient- and hospital-specific factors affect a system's ability to achieve OCO in patients undergoing radical cystectomy. OCO is directly associated with improved OS and has the potential to function as a composite performance metric for the quality of care in bladder cancer.

• Authors: Parth M Patel, Chirag P Doshi, Alex Belshoff, Marc Nelson, Patrick J Sweigert, Corinne Bunn, Sujay Kulshrestha, Marshall Baker, Michael Woods, Gopal N Gupta
• Journal: Urology (Urology) Vol. 143 Pg. 117-122 (09 2020) ISSN: 1527-9995 [Electronic] United States
• PMID: 32504682 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Topics

• Aged
• Carcinoma, Transitional Cell (diagnosis, mortality, pathology, surgery)
• Cystectomy (statistics & numerical data)
• Female
• Hospital Mortality
• Humans
• Kaplan-Meier Estimate
• Length of Stay (statistics & numerical data)
• Lymph Node Excision (statistics & numerical data)
• Male
• Margins of Excision
• Middle Aged
• Outcome Assessment, Health Care (methods, statistics & numerical data)
• Patient Readmission (statistics & numerical data)
• Retrospective Studies
• Risk Assessment (methods, statistics & numerical data)
• Time Factors
• Treatment Outcome
• Urinary Bladder Neoplasms (diagnosis, mortality, pathology, surgery)