title: Assessment of healthcare quality metrics: Length-of-stay, 30-day readmission, and 30-day mortality for radical nephrectomy with inferior vena cava thrombectomy.
abstract: BACKGROUND
  Length-of-stay (LOS), 30-day readmission, and 30-day mortality are metrics used to assess quality of care and provider reimbursement. Therefore, we investigated patient- and hospital-level characteristics associated with the three healthcare quality metrics for radical nephrectomy with inferior vena cava (IVC) thrombectomy.
  
  
  METHODS
  Using the National Cancer Data Base, we established a cohort of patients who received radical nephrectomy following the diagnosis of renal cell carcinoma (RCC) stage cT3b between 1998 and 2011. We then assessed the associations between patient- or hospital-level characteristics and LOS using multivariable negative binomial regression. We used multivariable logistic regression to determine the associations between the characteristics and 30-day readmission or 30-day mortality.
  
  
  RESULTS
  During the study period, 5768 patients were diagnosed with RCC stage cT3b and underwent radical nephrectomy. LOS ≤2 days and ≥9 days were associated with a higher likelihood of 30-day readmission (respective odds ratio [OR] 1.61 and 1.58) and 30-day mortality (respective OR 11.62 and 11.87). Older patients (60-79 years vs. <50 years) were less likely to experience 30-day readmission (OR 0.46-0.52). Older patients (≥80 years vs. <50 years, OR 3.67) and patients with a high index of comorbidity (Charlson comorbidity score ≥ 2 vs. 0, OR 1.95) were more likely to suffer 30-day mortality.
  
  
  CONCLUSIONS
  LOS is an important predictor of short-term readmission and mortality following radical nephrectomy with IVC thrombectomy. Older age and a high index of comorbidity also predict short-term mortality after the surgery.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH;
authors.forename: Y Joseph
authors.initials: YJ
authors.lastname: Hwang
authors.affiliation: Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH; ; Urology Institute, University Hospitals Case Medical Center, Cleveland, OH;
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Minnillo
authors.affiliation: Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH; ; Urology Institute, University Hospitals Case Medical Center, Cleveland, OH; ; Yale University, Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, New Haven, CT.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH; ; Urology Institute, University Hospitals Case Medical Center, Cleveland, OH;
authors.forename: Robert
authors.initials: R
authors.lastname: Abouassaly