Defining Factors Associated with High-quality Surgery Following Radical Cystectomy: Analysis of the British Association of Urological Surgeons Cystectomy Audit.
Bladder cancer
British Association of Urological Surgeons audit
Centralisation
Outcomes
Quality surgery
Radical cystectomy
Journal
European urology open science
ISSN: 2666-1683
Titre abrégé: Eur Urol Open Sci
Pays: Netherlands
ID NLM: 101771568
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
accepted:
24
08
2021
entrez:
1
11
2021
pubmed:
2
11
2021
medline:
2
11
2021
Statut:
epublish
Résumé
Radical cystectomy (RC) is associated with high morbidity. To evaluate healthcare and surgical factors associated with high-quality RC surgery. Patients within the prospective British Association of Urological Surgeons (BAUS) registry between 2014 and 2017 were included in this study. High-quality surgery was defined using pathological (absence of positive surgical margins and a minimum of a level I lymph node dissection template with a minimum yield of ten or more lymph nodes), recovery (length of stay ≤10 d), and technical (intraoperative blood loss <500 ml for open and <300 ml for minimally invasive RC) variables. A multilevel hierarchical mixed-effect logistic regression model was utilised to determine the factors associated with the receipt of high-quality surgery and index admission mortality. A total of 4654 patients with a median age of 70.0 yr underwent RC by 152 surgeons at 78 UK hospitals. The median surgeon and hospital operating volumes were 23.0 and 47.0 cases, respectively. A total of 914 patients (19.6%) received high-quality surgery. The minimum annual surgeon volume and hospital volume of ≥20 RCs/surgeon/yr and ≥68 RCs/hospital/yr, respectively, were the thresholds determined to achieve better rates of high-quality RC. The mixed-effect logistic regression model found that recent surgery (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.11-1.34, We report that annual surgeon operating volume and use of minimally invasive RC were predictors of high-quality surgery. Patients receiving high-quality surgery were independently associated with lower index admission mortality. Our results support the role of centralisation of complex oncology and implementation of a quality assurance programme to improve the delivery of care. In this registry study of patients treated with surgical excision of the urinary bladder for bladder cancer, we report that patients treated by a surgeon with a higher annual operative volume and a minimally invasive approach were associated with the receipt of high-quality surgery. Patients treated with high-quality surgery were more likely to be discharged alive following surgery.
Sections du résumé
BACKGROUND
BACKGROUND
Radical cystectomy (RC) is associated with high morbidity.
OBJECTIVE
OBJECTIVE
To evaluate healthcare and surgical factors associated with high-quality RC surgery.
DESIGN SETTING AND PARTICIPANTS
METHODS
Patients within the prospective British Association of Urological Surgeons (BAUS) registry between 2014 and 2017 were included in this study.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
METHODS
High-quality surgery was defined using pathological (absence of positive surgical margins and a minimum of a level I lymph node dissection template with a minimum yield of ten or more lymph nodes), recovery (length of stay ≤10 d), and technical (intraoperative blood loss <500 ml for open and <300 ml for minimally invasive RC) variables. A multilevel hierarchical mixed-effect logistic regression model was utilised to determine the factors associated with the receipt of high-quality surgery and index admission mortality.
RESULTS AND LIMITATIONS
CONCLUSIONS
A total of 4654 patients with a median age of 70.0 yr underwent RC by 152 surgeons at 78 UK hospitals. The median surgeon and hospital operating volumes were 23.0 and 47.0 cases, respectively. A total of 914 patients (19.6%) received high-quality surgery. The minimum annual surgeon volume and hospital volume of ≥20 RCs/surgeon/yr and ≥68 RCs/hospital/yr, respectively, were the thresholds determined to achieve better rates of high-quality RC. The mixed-effect logistic regression model found that recent surgery (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.11-1.34,
CONCLUSIONS
CONCLUSIONS
We report that annual surgeon operating volume and use of minimally invasive RC were predictors of high-quality surgery. Patients receiving high-quality surgery were independently associated with lower index admission mortality. Our results support the role of centralisation of complex oncology and implementation of a quality assurance programme to improve the delivery of care.
PATIENT SUMMARY
RESULTS
In this registry study of patients treated with surgical excision of the urinary bladder for bladder cancer, we report that patients treated by a surgeon with a higher annual operative volume and a minimally invasive approach were associated with the receipt of high-quality surgery. Patients treated with high-quality surgery were more likely to be discharged alive following surgery.
Identifiants
pubmed: 34723215
doi: 10.1016/j.euros.2021.08.005
pii: S2666-1683(21)00163-4
pmc: PMC8546928
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1-10Informations de copyright
© 2021 The Author(s).
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