Defining Factors Associated with High-quality Surgery Following Radical Cystectomy: Analysis of the British Association of Urological Surgeons Cystectomy Audit.
Eur Urol Open Sci
; 33: 1-10, 2021 Nov.
Article
em En
| MEDLINE
| ID: mdl-34723215
ABSTRACT
BACKGROUND:
Radical cystectomy (RC) is associated with high morbidity.OBJECTIVE:
To evaluate healthcare and surgical factors associated with high-quality RC surgery. DESIGN SETTING ANDPARTICIPANTS:
Patients within the prospective British Association of Urological Surgeons (BAUS) registry between 2014 and 2017 were included in this study. OUTCOME MEASUREMENTS AND STATISTICALANALYSIS:
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 ANDLIMITATIONS:
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, p < 0.001), laparoscopic/robotic RC (OR 1.85, 95% CI 1.45-2.37, p < 0.001), and higher annual surgeon operating volume (23.1-33.0 cases [OR 1.54, 95% CI 1.16-2.05, p = 0.003]; ≥33.1 cases [OR 1.64, 95% CI 1.18-2.29, p = 0.003]) were independently associated with high-quality surgery. High-quality surgery was an independent predictor of lower index admission mortality (OR 0.38, 95% CI 0.16-0.87, p = 0.021).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. PATIENTSUMMARY:
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.
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Base de dados:
MEDLINE
Tipo de estudo:
Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article