To assess textbook outcomes by hospital teaching status follow major surgery for genitourinary malignancies.
We used 100% national Medicare Provider Analysis and Review files from 2017-2020 to assess rates of textbook outcomes in undergoing bladder (i. e., radical cystectomy), kidney (i.e., radical or partial nephrectomy), and prostate (i.e., radical prostatectomy) surgery for genitourinary malignancies. The extent of integration of learners into each hospital's workforce-defined as major, minor and non- teaching-was the primary exposure. A textbook outcome, measured at the patient level, was defined as the absence of in-hospital mortality and mortality within 30 days of surgery, no readmission 30 days following discharge, no postoperative complication, and no prolonged length of stay.
Textbook outcomes were achieved in 51% (8,564/16,786) of patients after bladder cancer surgery, 70% (39,938/57,300) of patients after kidney cancer surgery, and 82% (50,408/61,385) of patients after prostate cancer surgery. After adjusting for patient- and hospital-level characteristics, teaching hospitals had higher rates of textbook outcomes in those undergoing bladder (50.7% vs 44.0%; p = 0.001), kidney (72.0% vs 69.7%; p = 0.02), and prostate (85.3% vs 81.0%; p < 0.001) surgery. This effect was attenuated, but not eliminated, by surgical volume in additional sensitivity analyses for bladder (OR: 1.20, 95% CI: 1.00 -1.42; p = 0.04) and prostate (OR: 1.15, 95% CI: 1.00-1.32; p = 0.04) surgery. There were no significant differences in kidney cancer surgery outcomes after adjusting for hospital volume (OR: 1.03, 95% CI: 0.93 - 1.14; p = 0.6).
Undergoing major cancer surgery at a teaching hospital was associated with an increased likelihood of receiving a textbook outcome. This effect was attenuated by volume but persisted for bladder and prostate surgery.
Urology. 2024 Jun 13 [Epub ahead of print]
Christopher P Dall, Xiu Liu, Kassem S Faraj, Arnav Srivastava, Samuel R Kaufman, Vahakn B Shahinian, Brent K Hollenbeck
Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA., Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA., Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA; Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA., Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA; Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.