In-hospital death and hospital-acquired complications among patients undergoing partial cystectomy for bladder cancer in the United States.
BACKGROUND
Partial cystectomy (PC) is a therapeutic option for select patients with bladder cancer, but its associated perioperative risks and costs are unknown. We estimated annual rates of PC in a nationally representative sample of hospitals, and analyzed whether hospital volume affects postoperative outcomes and costs in patients undergoing PC.


METHODS
From the Nationwide Inpatient Sample, we selected a weighted cohort of patients with bladder cancer who underwent PC between 2002 and 2008. Differences in length of stay, charges, and clinical outcomes were calculated based on operative volume, and univariate and multivariate regression models were fitted to predict in-hospital mortality (IHM) and hospital-acquired conditions.


RESULTS
A total of 10,780 patients with bladder cancer who underwent PC were identified with an annual rate between 1457 and 1628 cases. IHM rates were 1.8%, constituting 195 patients (between 9 and 46 annually). A total of 417 patients (3.9%) experienced a "never event" complication, which Medicare no longer reimburses. The mean annual hospital volume of patients who died was 1.7 cases/y compared with 2.4 cases/y among those without fatal complications. No cases of IHM were identified among hospitals performing at least 5 partial cystectomies/y. In a multivariate regression model increased hospital volume was independently associated with decreased mortality (odds ratio = 0.70, 95% confidence interval; 0.60-0.80).


CONCLUSIONS
Approximately 1 in 25 patients undergoing PC experience a hospital-acquired complication, and nearly 1 in 50 die as a result of the operation. For each additional case a hospital performs annually, the risk of IHM decreases by 30%.
James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: mkates@jhmi.edu.
Max
M
Kates
James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD.
Michael A
MA
Gorin
Department of Urology, Columbia University Medical Center, New York, NY.
Christopher M
CM
Deibert
James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD.
Phillip M
PM
Pierorazio
James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD.
Mark P
MP
Schoenberg
Department of Urology, Columbia University Medical Center, New York, NY.
James M
JM
McKiernan
James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD.
Trinity J
TJ
Bivalacqua
D000368:Aged; D015331:Cohort Studies; D015653:Cystectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000601:surgery*
Bladder cancer; Cystectomy; Outcomes; Surgical volume