title: Radical prostatectomy at academic versus nonacademic institutions: a population based analysis.
abstract: OBJECTIVE
  Radical prostatectomy outcomes may be better at academic institutions than at nonacademic centers. We examined the effect of academic status on 5 short-term radical prostatectomy outcomes.
  
  
  METHODS
  In the Health Care Utilization Project Nationwide Inpatient Sample we focused on radical prostatectomy performed within the 7 most contemporary years (2001 to 2007). We tested the rates of homologous blood transfusions and extended length of stay, as well as intraoperative and postoperative complications stratified according to institutional academic status. Multivariable logistic regression analyses further adjusted for confounding variables.
  
  
  RESULTS
  Overall 89,965 radical prostatectomies were identified, yielding a weighted national estimate of 442,811. Of those procedures 58.2% were recorded at academic institutions. Patients at academic institutions had a lower Charlson comorbidity index and more frequently had private insurance (p <0.001). Radical prostatectomy at academic institutions was associated with fewer blood transfusions (5.4% vs 7.4%), fewer postoperative complications (10.1% vs 12.9%) and lower rates of hospital stay above the median (18.0% vs 28.2%). On multivariable analyses institutional academic status exerted a protective effect on postoperative complication rates (OR 0.93, p = 0.02) and on rates of hospital stay in excess of the median (OR 0.91, p <0.001). Similarly radical prostatectomy performed at hospitals with a high annual caseload were less frequently associated with intraoperative (OR 0.8, p = 0.01) and postoperative (OR 0.63, p <0.001) complications, length of stay beyond the median (OR 0.19, p <0.001) and homologous blood transfusions (OR 0.35, p <0.001).
  
  
  CONCLUSIONS
  Even after adjusting for annual hospital caseload, radical prostatectomy performed at academic institutions is associated with better outcomes than radical prostatectomy performed at nonacademic institutions. This relationship illustrates averages and does not imply that academic institutions invariably offer better care.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan 48202, USA. trinh.qd@gmail.com
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Jan
authors.initials: J
authors.lastname: Schmitges
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Jesse
authors.initials: J
authors.lastname: Sammon
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011468:Prostatectomy