Hospital-level Variation in the Quality of Benign Inpatient Urologic Surgery

Abstract

Objective To examine hospital-level variation in outcomes following benign urologic surgeries given that hospital level variation in surgical outcomes can portend quality and appropriateness of care concerns and identify quality improvement opportunities in perioperative care. Methods Using the Washington State Comprehensive Hospital Abstract Reporting System (CHARS), we identified patients that underwent transurethral resection of the prostate (TURP), percutaneous nephrostolithotomy (PCNL), and pyeloplasty from 2003–2008. We classified prolonged postoperative length of stay (LOS) as that exceeding the 75th percentile, and we measured the rate of Agency for Healthcare Quality Patient Safety Indicators (PSIs), readmissions, and death. We calculated hospital-specific observed-to-expected event rates using random effects multilevel multivariable models adjusted for age and comorbidity. Results We identified 6,699 TURP patients at 54 different hospitals, 2,541 PCNL patients at 45 hospitals, and 584 pyeloplasty patients at 36 hospitals. Complication rates were highest after PCNL (22.9% prolonged LOS vs. 17.3% for TURP and 13.9% for pyeloplasty, p<0.001; 3.4% 90-day mortality vs. 0.6% for TURP and 0% for pyeloplasty). Hospital-level variation was most substantial for LOS after TURP and pyeloplasty (8.1% and 14.3% of variance in prolonged LOS, respectively). Conclusions Hospital-level variation is common after benign inpatient urologic surgeries and may relate to difference in perioperative provider practice patterns. The morbidity of PCNL in this study was higher than expected and merits further investigation.

A Novel Metric for Hospital Quality in Kidney Cancer Surgery: A Veterans Affairs National Health System Validation of Concept

“…5–10 This is despite the increasing and concerning evidence that significant variations exist in the quality of surgical care at the hospital level nationwide. 11–15 Importantly, this has been shown for subspecialty urological care and patients with kidney cancer in particular. 11,12,16,17 Therefore, the development and implementation of quality indicators (QIs) to measure oncologic surgical care performance at the hospital level is essential, especially in the setting of large and geographically diverse health care systems.…”

“…11e15 Importantly, this has been shown for subspecialty urological care and patients with kidney cancer in particular. 11,12,16,17 Therefore, the development and implementation of quality indicators (QIs) to measure oncologic surgical care performance at the hospital level is essential, especially in the setting of large and geographically diverse health care systems. 18 National guidelines recommend the use of partial nephrectomy (PN) for the surgical management of small renal masses and the use of radical nephrectomy for larger tumors with increased oncologic potential.…”