title: Hospital-level Variation in the Quality of Benign Inpatient Urologic Surgery.
abstract: OBJECTIVE
  To examine hospital-level variation in outcomes following benign urologic surgeries given that hospital-level variation in surgical outcomes can portend quality and appropriateness of care concerns and identify quality improvement opportunities in perioperative care.
  
  
  METHODS
  Using the Washington State Comprehensive Hospital Abstract Reporting System, we identified patients who underwent transurethral resection of the prostate (TURP), percutaneous nephrostolithotomy (PCNL), and pyeloplasty from 2003 to 2008. We classified prolonged postoperative length of stay (LOS) as that exceeding the 75th percentile, and we measured the rate of Agency for Healthcare Quality Patient Safety Indicators, readmissions, and death. We calculated hospital-specific observed-to-expected event rates using random effects multilevel multivariable models adjusted for age and comorbidity.
  
  
  RESULTS
  We identified 6699 TURP patients at 54 hospitals, 2541 PCNL patients at 45 hospitals, and 584 pyeloplasty patients at 36 hospitals. Complication rates were highest after PCNL (22.9% prolonged LOS vs 17.3% for TURP and 13.9% for pyeloplasty, P < .001; 3.4% 90-day mortality vs 0.6% for TURP and 0% for pyeloplasty). Hospital-level variation was most substantial for LOS after TURP and pyeloplasty (8.1% and 14.3% of variance in prolonged LOS, respectively).
  
  
  CONCLUSIONS
  Hospital-level variation is common after benign inpatient urologic surgeries and may relate to difference in perioperative provider practice patterns. The morbidity of PCNL in this study was higher than expected and merits further investigation.
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Hilary
authors.initials: H
authors.lastname: Zetlen
authors.affiliation: College of Nursing, Washington State University, Spokane, WA.
authors.forename: Kenn B
authors.initials: KB
authors.lastname: Daratha
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Harper
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Hunter
authors.initials: H
authors.lastname: Wessells
authors.affiliation: College of Medical Sciences, Washington State University, Spokane, WA.
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Roberts
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA. Electronic address: jlgore@u.washington.edu.
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
mesh_terms: D000368:Aged; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000601:surgery*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000592:standards*; D016896:Treatment Outcome; D014861:Washington