{"title":"教学医院与泌尿系统癌症大手术后的教科书成果。","authors":"","doi":"10.1016/j.urology.2024.06.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To assess textbook outcomes by hospital teaching status following major surgery for urologic cancers.</p></div><div><h3>Methods</h3><p><span><span>We used 100% national Medicare Provider Analysis and Review files from 2017-2020 to assess rates of textbook outcomes in patients undergoing bladder<span> (ie, radical cystectomy), kidney (ie, radical or partial nephrectomy), and prostate (ie, radical prostatectomy) surgery for genitourinary malignancies. The extent of integration of learners into each hospital’s workforce—defined as major, minor, and non teaching hospitals—was the primary exposure. A textbook outcome, measured at the patient level, was defined as the </span></span>absence of in-hospital mortality and mortality within 30</span> <!-->days of surgery, no readmission 30<!--> <span>days following discharge, no postoperative complication, and no prolonged length of stay.</span></p></div><div><h3>Results</h3><p><span><span>Textbook outcomes were achieved in 51% (8564/16,786) of patients after bladder cancer<span> surgery, 70% (39,938/57,300) of patients after kidney cancer surgery, and 82% (50,408/61,385) of patients after </span></span>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%; </span><em>P</em> = .001), kidney (72.0% vs 69.7%; <em>P</em> = .02), and prostate (85.3% vs 81.0%; <em>P</em> <.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; <em>P</em> = .04) and prostate (OR: 1.15, 95% CI: 1.00-1.32; <em>P</em> = .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; <em>P</em> = .6).</p></div><div><h3>Conclusion</h3><p>Undergoing major cancer surgery at a teaching hospital was associated with an increased likelihood of achieving a textbook outcome. This effect was attenuated by volume but persisted for bladder and prostate surgery.</p></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Teaching Hospitals and Textbook Outcomes After Major Urologic Cancer Surgery\",\"authors\":\"\",\"doi\":\"10.1016/j.urology.2024.06.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>To assess textbook outcomes by hospital teaching status following major surgery for urologic cancers.</p></div><div><h3>Methods</h3><p><span><span>We used 100% national Medicare Provider Analysis and Review files from 2017-2020 to assess rates of textbook outcomes in patients undergoing bladder<span> (ie, radical cystectomy), kidney (ie, radical or partial nephrectomy), and prostate (ie, radical prostatectomy) surgery for genitourinary malignancies. The extent of integration of learners into each hospital’s workforce—defined as major, minor, and non teaching hospitals—was the primary exposure. A textbook outcome, measured at the patient level, was defined as the </span></span>absence of in-hospital mortality and mortality within 30</span> <!-->days of surgery, no readmission 30<!--> <span>days following discharge, no postoperative complication, and no prolonged length of stay.</span></p></div><div><h3>Results</h3><p><span><span>Textbook outcomes were achieved in 51% (8564/16,786) of patients after bladder cancer<span> surgery, 70% (39,938/57,300) of patients after kidney cancer surgery, and 82% (50,408/61,385) of patients after </span></span>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%; </span><em>P</em> = .001), kidney (72.0% vs 69.7%; <em>P</em> = .02), and prostate (85.3% vs 81.0%; <em>P</em> <.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; <em>P</em> = .04) and prostate (OR: 1.15, 95% CI: 1.00-1.32; <em>P</em> = .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; <em>P</em> = .6).</p></div><div><h3>Conclusion</h3><p>Undergoing major cancer surgery at a teaching hospital was associated with an increased likelihood of achieving a textbook outcome. This effect was attenuated by volume but persisted for bladder and prostate surgery.</p></div>\",\"PeriodicalId\":23415,\"journal\":{\"name\":\"Urology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0090429524004515\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0090429524004515","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的根据医院教学状况评估泌尿生殖系统恶性肿瘤大手术后的教科书结果:我们使用2017-2020年100%的全国医疗保险提供者分析和审查档案,评估接受膀胱(即根治性膀胱切除术)、肾(即根治性或部分肾切除术)和前列腺(即根治性前列腺切除术)手术治疗泌尿生殖系统恶性肿瘤的教科书结果率。学习者融入每家医院员工队伍的程度,即主要、次要和非教学人员,是主要的接触点。在患者层面衡量的教科书式结果被定义为无院内死亡和手术后 30 天内无死亡、出院后 30 天内无再入院、无术后并发症、无住院时间延长:51%(8,564/16,786 例)的膀胱癌手术患者、70%(39,938/57,300 例)的肾癌手术患者和 82%(50,408/61,385 例)的前列腺癌手术患者达到了教科书规定的治疗效果。在对患者和医院层面的特征进行调整后,教学医院的膀胱癌(50.7% vs 44.0%; p = 0.001)、肾癌(72.0% vs 69.7%; p = 0.02)和前列腺癌(85.3% vs 81.0%; p < 0.001)手术患者的教科书结果率更高。在膀胱(OR:1.20,95% CI:1.00-1.42;P = 0.04)和前列腺(OR:1.15,95% CI:1.00-1.32;P = 0.04)手术的额外敏感性分析中,手术量的影响有所减弱,但并未消除。调整医院规模后,肾癌手术结果无明显差异(OR:1.03,95% CI:0.93 - 1.14;P = 0.6):结论:在教学医院接受大型癌症手术与获得教科书结果的可能性增加有关。结论:在教学医院接受大型癌症手术与获得 "教科书式 "结果的可能性增加有关,这种影响因医院规模而减弱,但在膀胱和前列腺手术中持续存在。
Teaching Hospitals and Textbook Outcomes After Major Urologic Cancer Surgery
Objective
To assess textbook outcomes by hospital teaching status following major surgery for urologic cancers.
Methods
We used 100% national Medicare Provider Analysis and Review files from 2017-2020 to assess rates of textbook outcomes in patients undergoing bladder (ie, radical cystectomy), kidney (ie, radical or partial nephrectomy), and prostate (ie, radical prostatectomy) surgery for genitourinary malignancies. The extent of integration of learners into each hospital’s workforce—defined as major, minor, and non teaching hospitals—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.
Results
Textbook outcomes were achieved in 51% (8564/16,786) 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 = .001), kidney (72.0% vs 69.7%; P = .02), and prostate (85.3% vs 81.0%; P <.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 = .04) and prostate (OR: 1.15, 95% CI: 1.00-1.32; P = .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 = .6).
Conclusion
Undergoing major cancer surgery at a teaching hospital was associated with an increased likelihood of achieving a textbook outcome. This effect was attenuated by volume but persisted for bladder and prostate surgery.
期刊介绍:
Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology
The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.