title: Minimally invasive cystectomy is associated with improved perioperative patient safety outcomes compared with open cystectomy in a national cohort.
abstract: OBJECTIVE
  To compare perioperative patient safety outcomes of minimally invasive cystectomy (MIC) with open cystectomy (OC) in a national cohort. Comparative outcomes data based on validated metrics are sparse for MIC, an emerging treatment for bladder cancer.
  
  
  METHODS
  We identified patients undergoing MIC and OC for bladder cancer from 2005 to 2010 using the US Nationwide Inpatient Sample. We compared perioperative outcomes using Patient Safety Indicators (PSIs), validated metrics developed by the Agency for Healthcare Research and Quality, and used multivariate regression analyses to generate adjusted odds ratios.
  
  
  RESULTS
  Between 2005 and 2010, 42,919 patients underwent cystectomy. During this period, the prevalence of MIC increased from 0.8% to 10.3% of all cystectomies. Compared with OC, MIC patients were more likely to be male (P = .019) and treated at large teaching hospitals (P <.001). There were no significant differences in age, race, Charlson index, or region between groups. The median lengths of stay were 8 and 7 days for OC and MIC, respectively (P <.001). In multivariate regression analyses, MIC was associated with a 30% decreased likelihood of any PSI (odds ratio, 0.71; P = .038). Although the occurrence of any PSI was associated with increased mortality (P <.001), there were no significant differences in mortality between OC and MIC.
  
  
  CONCLUSIONS
  The prevalence of MIC has substantially increased in recent years. Patients undergoing MIC had superior perioperative patient safety outcomes as measured by PSIs. Further study is needed to explain these patterns and to promote the continued safe diffusion of this technology.
authors: Department of Urology, UC San Diego Health System, San Diego, CA.
authors: Seth A
authors: SA
authors: Cohen
authors: Department of Urology, UC San Diego Health System, San Diego, CA.
authors: Hossein S
authors: HS
authors: Mirheydar
authors: Department of Urology, UC San Diego Health System, San Diego, CA; Division of Urologic Oncology, UC San Diego Moores Cancer Center, La Jolla, CA; VA San Diego Healthcare System, San Diego, CA.
authors: J Kellogg
authors: JK
authors: Parsons
authors: Division of Urologic Oncology, UC San Diego Moores Cancer Center, La Jolla, CA.
authors: Kerrin L
authors: KL
authors: Palazzi
authors: Department of Urology, UC San Diego Health System, San Diego, CA; Division of Urologic Oncology, UC San Diego Moores Cancer Center, La Jolla, CA.
authors: Michael A
authors: MA
authors: Liss
authors: Department of Surgery, UC San Diego Health System, San Diego, CA.
authors: David C
authors: DC
authors: Chang
authors: Department of Urology, UC San Diego Health System, San Diego, CA; Division of Urologic Oncology, UC San Diego Moores Cancer Center, La Jolla, CA; VA San Diego Healthcare System, San Diego, CA.
authors: Christopher J
authors: CJ
authors: Kane
authors: Department of Urology, UC San Diego Health System, San Diego, CA; Division of Urologic Oncology, UC San Diego Moores Cancer Center, La Jolla, CA; VA San Diego Healthcare System, San Diego, CA. Electronic address: kkader@ucsd.edu.
authors: A Karim
authors: AK
authors: Kader
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D061214:Patient Safety; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome