Defining radical cystectomy using the ICD-10 procedure coding system

Lyon, Timothy D.; Faraj, Kassem; Brennan, Emily; Tyson, Mark D.; Boorjian, Stephen A.; Spaulding, Aaron

doi:10.1016/j.urolonc.2021.09.013

Cited by 11 publications

(9 citation statements)

References 14 publications

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“…Within the NIS database (2016–2019), we focused on patients with a primary diagnosis of bladder cancer (International Classification of Disease, Tenth Revision, Clinical Modification [ICD-10-CM] codes C67.0–C67.6, C67.8, C67.9) and without any prior cancer diagnosis (absence of ICD-10-CM code Z85.xx). Additionally, all patients included were aged >18 years and underwent RC, which was identified by ICD-10 Procedure Coding System [ICD-10-PCS] codes, as recently reported and validated by Lyon et al [ 14 ]. Among those, patients with secondary ICD-10-CM codes indicating lymph-node invasion or metastatic stage were excluded from further analyses.…”

Section: Methodsmentioning

confidence: 99%

Effect of Neoadjuvant Chemotherapy on Complications, in-Hospital Mortality, Length of Stay and Total Hospital Costs in Bladder Cancer Patients Undergoing Radical Cystectomy

Hoeh

Flammia

Hohenhorst

et al. 2022

Cancers

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Background: To test for differences in complication rates, in-hospital mortality, length of stay (LOS) and total hospital costs (THCs) in patients treated with neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC). Methods: Within the National (Nationwide) Inpatient Sample (NIS) database (2016–2019), we identified RC-treated, non-metastatic, lymph-node negative bladder cancer patients, stratified by NAC status. Trend analyses, multivariable logistic, multivariable Poisson and multivariable linear regression models were used. Results: We identified 4347 RC-treated bladder cancer patients. Of those, 805 (19%) received NAC prior to RC. Overall, complications rates did not differ (65 vs. 66%; p = 0.7). However, NAC patients harbored lower rates of surgical site (6 vs. 9%), cardiac (13 vs. 19%) and genitourinary (5.5 vs. 9.7%) complications. In-hospital mortality (<1.7 vs. 1.8%) and LOS (6 vs. 7 days) was lower in NAC patients (all p < 0.05). Moreover, NAC was an independent predictor of shorter LOS in multivariable Poisson regression models (Risk ratio: 0.86; p < 0.001) and an independent predictor for higher THCs in multivariable linear regression models (Odds ratio: 1474$; p = 0.02). Conclusion: NAC was not associated with higher complication rates and in-hospital mortality. Contrary, NAC was associated with shorter LOS, yet moderately higher THCs. The current analysis suggests no detriment from NAC in the context of RC.

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Section: Methodsmentioning

confidence: 99%

Effect of Neoadjuvant Chemotherapy on Complications, in-Hospital Mortality, Length of Stay and Total Hospital Costs in Bladder Cancer Patients Undergoing Radical Cystectomy

Hoeh

Flammia

Hohenhorst

et al. 2022

Cancers

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“…Encounters involving RCIC urinary diversion for bladder cancer between January 2015 and March 2020 were identified via ICD (International Classification of Diseases) diagnosis codes for bladder cancer and radical cystectomy, in combination with CPT (Current Procedural Terminology) codes to identify urinary diversion, similarly to previously validated methodology. 12 Robotic procedures were identified with HCPCS S2900 (Supplemental Table 1, https://www.jurology.com). The use of parenteral antibiotics and antifungal prophylaxis during the index hospitalization for cystectomy was identified via charge codes (Supplemental Table 2, https://www.jurology.com).…”

Section: Methodsmentioning

confidence: 99%

National Adherence to Guidelines for Antimicrobial Prophylaxis for Patients Undergoing Radical Cystectomy

et al. 2023

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Purpose: The sentinel reference for antibiotic prophylaxis for radical cystectomy with ileal conduit in the AUA Guidelines reports data from 2003-2013 and has not been updated in the interim. Here, we assess adherence to antibiotic prophylaxis guidelines among patients undergoing radical cystectomy with ileal conduit for bladder cancer using a large national database. As a secondary objective, we assess the association between antimicrobial use and postoperative infection during the index admission following cystectomy. Materials and Methods: The Premier Healthcare Database was queried for all patients undergoing cystectomy with ileal conduit with diagnosis of bladder cancer between 2015 and 2020. Antibiotics used and the duration of use was determined by charge codes and grouped as guidelines-based or not according to 2019 AUA Guidelines. Association with infectious complications was assessed by logistic mixed effects regression models. Results: Among 6,708 patients undergoing cystectomy with ileal conduit, only 28% (1,843/6,708) were given prophylaxis according to AUA guidelines; 1.8% (121/6,708) of patients received an antifungal and 37% (2,482/6,708) received extended duration prophylaxis beyond postoperative day 1. Patients who received guidelines-based prophylaxis were less likely to be diagnosed with a urinary tract infection (21% vs 24%, P [ .04), pyelonephritis (5.1% vs 7.7%, P < .001), bacterial infection (24% vs 27%, P [ .03), or pneumonia (12% vs 17%, P < .001). There was no statistically significant difference in clostridium difficile infection between guidelines-based and nonguidelines-based prophylaxis (3.2% vs 3.7%, P [ .32). In a multivariable logistic regression adjusting for age, race, insurance, and hospital and provider characteristics, nonguideline antibiotic prophylaxis (OR 1.27 [1.12, 1.43], P < .001) was associated with an increased odds of infectious events, whereas a robotic approach (OR 0.82 [0.73, 0.92], P < .001) was associated with lower odds. Conclusions: Seventy-three percent of patients fail to receive guideline-based antibiotic prophylaxis when undergoing radical cystectomy with conduit, which was largely driven by extended duration antibiotic use. Despite the shorter duration of antibiotics, we found that guideline-based prophylaxis was associated with a 25% decrease in the odds of infectious complications. While residual confounding is possible, these data support current AUA guidelines and suggest a need for outreach to improve guideline adherence.

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“…Within the NIS database (2016-2019), we selected patients (aged >18 years) with a primary diagnosis of bladder cancer (International Classification of Disease, Tenth Revision, Clinical Modification [ICD-10-CM] codes C67.0-C67.6, C67.8, C67.9). Of those, patients treated with radical cystectomy were selected relying on Procedure Coding System (ICD-10-PCS), as recently reported and validated by Lyon et al 16,17 ICD-10-PCS codes were also used to distinguish between RARC versus ORC versus laparoscopic RC. 16 Additionally, patients with secondary ICD-10-CM codes indicating lymph-node invasion or metastatic stage were excluded from further analyses.…”

Section: Study Populationmentioning

confidence: 99%

“…Of those, patients treated with radical cystectomy were selected relying on Procedure Coding System (ICD-10-PCS), as recently reported and validated by Lyon et al 16,17 ICD-10-PCS codes were also used to distinguish between RARC versus ORC versus laparoscopic RC. 16 Additionally, patients with secondary ICD-10-CM codes indicating lymph-node invasion or metastatic stage were excluded from further analyses.…”

Section: Study Populationmentioning

confidence: 99%

Outcomes of robotic‐assisted versus open radical cystectomy in a large‐scale, contemporary cohort of bladder cancer patients

Hoeh

Flammia

Hohenhorst

et al. 2022

Journal of Surgical Oncology

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Background and Objectives: To test for differences in perioperative outcomes and total hospital costs (THC) in nonmetastatic bladder cancer patients undergoing open (ORC) versus robotic-assisted radical cystectomy (RARC).Methods: We relied on the National Inpatient Sample database (2016)(2017)(2018)(2019).Statistics consisted of trend analyses, multivariable logistic, Poisson, and linear regression models.Results: Of 5280 patients, 1876 (36%) versus 3200 (60%) underwent RARC versus ORC. RARC increased from 32% to 41% (estimated annual percentage

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Defining radical cystectomy using the ICD-10 procedure coding system

Cited by 11 publications

References 14 publications

Effect of Neoadjuvant Chemotherapy on Complications, in-Hospital Mortality, Length of Stay and Total Hospital Costs in Bladder Cancer Patients Undergoing Radical Cystectomy

Effect of Neoadjuvant Chemotherapy on Complications, in-Hospital Mortality, Length of Stay and Total Hospital Costs in Bladder Cancer Patients Undergoing Radical Cystectomy

National Adherence to Guidelines for Antimicrobial Prophylaxis for Patients Undergoing Radical Cystectomy

Outcomes of robotic‐assisted versus open radical cystectomy in a large‐scale, contemporary cohort of bladder cancer patients

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