Teaching Hospitals and Textbook Outcomes After Major Urologic Cancer Surgery

• Published in: Urology (Ridgewood, N.J.) N.J.), 2024-09, Vol.191, p.64-70
• Main Authors: Dall, Christopher P., Liu, Xiu, Faraj, Kassem S., Srivastava, Arnav, Kaufman, Samuel R., Shahinian, Vahakn B., Hollenbeck, Brent K.
• Format: Article
• Language: English
• Subjects: Aged; Cystectomy - adverse effects; Cystectomy - methods; Female; Hospital Mortality; Hospitals, Teaching - statistics & numerical data; Humans; Kidney Neoplasms - mortality; Kidney Neoplasms - surgery; Male; Nephrectomy - adverse effects; Nephrectomy - methods; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic Neoplasms - mortality; Prostatic Neoplasms - surgery; United States - epidemiology; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - surgery; Urologic Neoplasms - mortality; Urologic Neoplasms - surgery; Urologic Surgical Procedures - adverse effects; Urologic Surgical Procedures - statistics & numerical data
• ISSN: 0090-4295; 1527-9995; 1527-9995
• DOI: 10.1016/j.urology.2024.06.007

To assess textbook outcomes by hospital teaching status following major surgery for urologic cancers. We used 100% national Medicare Provider Analysis and Review files from 2017-2020 to assess rates of textbook outcomes in patients undergoing bladder (ie, radical cystectomy), kidney (ie, radical or partial nephrectomy), and prostate (ie, radical prostatectomy) surgery for genitourinary malignancies. The extent of integration of learners into each hospital’s workforce—defined as major, minor, and non teaching hospitals—was the primary exposure. A textbook outcome, measured at the patient level, was defined as the absence of in-hospital mortality and mortality within 30days of surgery, no readmission 30days following discharge, no postoperative complication, and no prolonged length of stay. Textbook outcomes were achieved in 51% (8564/16,786) of patients after bladder cancer surgery, 70% (39,938/57,300) of patients after kidney cancer surgery, and 82% (50,408/61,385) of patients after prostate cancer surgery. After adjusting for patient- and hospital-level characteristics, teaching hospitals had higher rates of textbook outcomes in those undergoing bladder (50.7% vs 44.0%; P = .001), kidney (72.0% vs 69.7%; P = .02), and prostate (85.3% vs 81.0%; P