In-hospital death and hospital-acquired complications among patients undergoing partial cystectomy for bladder cancer in the United States

Max Kates, Michael A. Gorin, Christopher M. Deibert, Phillip M. Pierorazio, Mark P. Schoenberg, James M. McKiernan, Trinity J. Bivalacqua

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Partial cystectomy (PC) is a therapeutic option for select patients with bladder cancer, but its associated perioperative risks and costs are unknown. We estimated annual rates of PC in a nationally representative sample of hospitals, and analyzed whether hospital volume affects postoperative outcomes and costs in patients undergoing PC. Methods: From the Nationwide Inpatient Sample, we selected a weighted cohort of patients with bladder cancer who underwent PC between 2002 and 2008. Differences in length of stay, charges, and clinical outcomes were calculated based on operative volume, and univariate and multivariate regression models were fitted to predict in-hospital mortality (IHM) and hospital-acquired conditions. Results: A total of 10,780 patients with bladder cancer who underwent PC were identified with an annual rate between 1457 and 1628 cases. IHM rates were 1.8%, constituting 195 patients (between 9 and 46 annually). A total of 417 patients (3.9%) experienced a "never event" complication, which Medicare no longer reimburses. The mean annual hospital volume of patients who died was 1.7 cases/y compared with 2.4 cases/y among those without fatal complications. No cases of IHM were identified among hospitals performing at least 5 partial cystectomies/y. In a multivariate regression model increased hospital volume was independently associated with decreased mortality (odds ratio = 0.70, 95% confidence interval; 0.60-0.80). Conclusions: Approximately 1 in 25 patients undergoing PC experience a hospital-acquired complication, and nearly 1 in 50 die as a result of the operation. For each additional case a hospital performs annually, the risk of IHM decreases by 30%.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
Volume32
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

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Cystectomy
Urinary Bladder Neoplasms
Hospital Mortality
Iatrogenic Disease
Costs and Cost Analysis
Medical Errors
Mortality
Medicare
Inpatients
Length of Stay
Odds Ratio
Confidence Intervals

Keywords

  • Bladder cancer
  • Cystectomy
  • Outcomes
  • Surgical volume

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

In-hospital death and hospital-acquired complications among patients undergoing partial cystectomy for bladder cancer in the United States. / Kates, Max; Gorin, Michael A.; Deibert, Christopher M.; Pierorazio, Phillip M.; Schoenberg, Mark P.; McKiernan, James M.; Bivalacqua, Trinity J.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 32, No. 1, 01.2014.

Research output: Contribution to journalArticle

Kates, Max ; Gorin, Michael A. ; Deibert, Christopher M. ; Pierorazio, Phillip M. ; Schoenberg, Mark P. ; McKiernan, James M. ; Bivalacqua, Trinity J. / In-hospital death and hospital-acquired complications among patients undergoing partial cystectomy for bladder cancer in the United States. In: Urologic Oncology: Seminars and Original Investigations. 2014 ; Vol. 32, No. 1.
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AB - Background: Partial cystectomy (PC) is a therapeutic option for select patients with bladder cancer, but its associated perioperative risks and costs are unknown. We estimated annual rates of PC in a nationally representative sample of hospitals, and analyzed whether hospital volume affects postoperative outcomes and costs in patients undergoing PC. Methods: From the Nationwide Inpatient Sample, we selected a weighted cohort of patients with bladder cancer who underwent PC between 2002 and 2008. Differences in length of stay, charges, and clinical outcomes were calculated based on operative volume, and univariate and multivariate regression models were fitted to predict in-hospital mortality (IHM) and hospital-acquired conditions. Results: A total of 10,780 patients with bladder cancer who underwent PC were identified with an annual rate between 1457 and 1628 cases. IHM rates were 1.8%, constituting 195 patients (between 9 and 46 annually). A total of 417 patients (3.9%) experienced a "never event" complication, which Medicare no longer reimburses. The mean annual hospital volume of patients who died was 1.7 cases/y compared with 2.4 cases/y among those without fatal complications. No cases of IHM were identified among hospitals performing at least 5 partial cystectomies/y. In a multivariate regression model increased hospital volume was independently associated with decreased mortality (odds ratio = 0.70, 95% confidence interval; 0.60-0.80). Conclusions: Approximately 1 in 25 patients undergoing PC experience a hospital-acquired complication, and nearly 1 in 50 die as a result of the operation. For each additional case a hospital performs annually, the risk of IHM decreases by 30%.

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