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MP63-15 VALIDATION OF PERI-OPERATIVE BLOOD TRANSFUSION AS A SURGICAL QUALITY INDICATOR OF CYSTECTOMY: A POPULATION-BASED STUDY
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
per year compared to only 4 hospitals in 2010. It should be noted, however, that since 2011 salvage RCs and RCs performed for other malignancies were registered as well that may have been of influence on the categories shift. Among the 4 categories, there was no substantial difference in the performance of lymphadenectomy (90-100%), number of lymph nodes removed (median 10-15) and positive surgical margin rate (6.4-8.3%). In general, orthotopic neobladder performance was low, but higher in category IV compared to lower categories (20% vs <15%). Between 2011-2013, the 30-day mortality rate was 0%, 2.6%, 2,5% and 2.7% for cat I-IV, respectively. Neo-adjuvant chemotherapy was more often used in categories III and IV. Overall, neoadjuvant chemotherapy use increased from 8.1% in 2008 to 18.2% in 2013. CONCLUSIONS: The introduction of a minimum cystectomy volume policy has resulted centralization of BC care in the Netherlands. However, a clear association between higher hospital volume and quality of BC care was not observed.
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CONCLUSIONS: Although rates are decreasing, these data suggest very high utilization rate of PBT at time of cystectomy in routine clinical practice. PBT is associated with substantially lower long-term survival. This association persists despite adjustment for provider volume, suggesting that PBT is a valid indicator of surgical care of bladder cancer.
Source of Funding: None Source of Funding: None
MP63-15
MP63-16
VALIDATION OF PERI-OPERATIVE BLOOD TRANSFUSION AS A SURGICAL QUALITY INDICATOR OF CYSTECTOMY: A POPULATION-BASED STUDY
UNPLANNED REOPERATION FOLLOWING OPEN AND MINIMALLY INVASIVE RADICAL CYSTECTOMY. ANALYSIS OF THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE.
D. Robert Siemens*, Melanie Jaeger, Xuejiao Wei, Francisco Vera-Badillo, Christopher Booth, Kingston, Canada
Ahmad Shabsigh*, Columbus, OH
INTRODUCTION AND OBJECTIVES: Previous single-center studies of peri-operative blood transfusion (PBT) at the time of radical cystectomy have suggested a potential association with longterm cancer survival. Here we describe the frequency of PBT at cystectomy in routine clinical practice and evaluate its effect on outcomes in order to explore its utility as a quality indicator of surgical care. METHODS: Electronic records of treatment and surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients with bladder cancer who underwent cystectomy and PBT between 2000-2008. Hospital discharge records identified PBT. Modified Poisson regression model was used to determine the factors associated with PBT. A Cox proportional hazards regression model was used to explore the association between PBT and overall (OS) and cancer-specific (CSS) survival. RESULTS: Among the 2593 patients with cystectomy in 20002008, 62% received an allogenic red blood cell transfusion. The frequency of PBT decreased over the study period (from 68% in 2000 to 54% in 2008, p<0.001). Factors associated with receiving PBT included age (80+ years RR 1.25, 95%CI 1.14-1.39), sex (female RR 1.40, 95% CI 1.33-1.48), greater co-morbidity (RR 1.11, 95%CI 1.03-1.20), T stage (T4 tumor RR 1.24, 95%CI 1.12-1.36) and surgeon volume (lowest quartile RR 1.18, 95%CI 1.08-1.28). Utilization of PBT was associated with inferior early outcomes including median length of stay (11 days vs 9 days, p<0.001), 90-day readmission rate (38% vs 29%, p<0.001) and 90-day mortality (11% vs 4%, p<0.001). OS (32% vs 47%, p<0.001) and CSS (38% vs 54%, p<0.001) at five years were lower among patients with PBT. These differences in long-term survival persisted on multivariate analysis (OS HR 1.33,95% CI 1.20-1.48; CSS HR 1.39, 95% CI 1.23-1.56).
INTRODUCTION AND OBJECTIVES: To define the rates and the predictors of unplanned reoperation (UR) following open (ORC) and minimally invasive radical cystectomy (MIRC) for bladder cancer. METHODS: We performed a retrospective review of prospectively collected database (NSQIP) of all patients who underwent open and minimally invasive radical cystectomy between 2005 and 2013. Patient’s demographics, unplanned reoperation rate and its causes were reported. Multivariate analysis was performed to characterize predictors of unplanned reoperation. RESULTS: Between 2005 and 2013, a total of 2279 cases were identified. 142 patients (6.2%) underwent unplanned reoperation within 30 days of cystectomy. Data regarding possible causes of reoperation was available for 2012 dataset. In 2012, 71 patients out of 1010 patients (7.0%) underwent reoperation following cystectomy. Wound dehiscence (27.9%), intestinal obstruction (22.1%), intestinal perforation (10.2%) and urinary anastmosis related complications (10.2%) were the most common causes of reoperation. Unplanned reoperation was lower in the MIRC group (2.2 % vs. 6.4 %), P¼ 0.06). Logistic regression analysis was performed to define the predictors of reoperation. In multivariate analysis disseminated cancer (OR 1.99, 95% CI 1.05-3.77, P¼ 0.03), preoperative dyspnea (OR 1.78, 95% CI 1.10-2.88, P¼ 0.01), male gender (OR 1.62, 95% CI 1.03-2.56, P0.04) and BMI (OR 1.05, 95% CI 1.02-1.08, P¼ 0.001) were independent risk factors of unplanned reoperation. CONCLUSIONS: Both ORC and MIRC have comparable outcomes regarding unplanned reoperation rates. Wound and bowel related complications are the major indications for unplanned reoperation following radical cystectomy. Source of Funding: Department Fundings
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
per year compared to only 4 hospitals in 2010. It should be noted, however, that since 2011 salvage RCs and RCs performed for other malignancies were registered as well that may have been of influence on the categories shift. Among the 4 categories, there was no substantial difference in the performance of lymphadenectomy (90-100%), number of lymph nodes removed (median 10-15) and positive surgical margin rate (6.4-8.3%). In general, orthotopic neobladder performance was low, but higher in category IV compared to lower categories (20% vs <15%). Between 2011-2013, the 30-day mortality rate was 0%, 2.6%, 2,5% and 2.7% for cat I-IV, respectively. Neo-adjuvant chemotherapy was more often used in categories III and IV. Overall, neoadjuvant chemotherapy use increased from 8.1% in 2008 to 18.2% in 2013. CONCLUSIONS: The introduction of a minimum cystectomy volume policy has resulted centralization of BC care in the Netherlands. However, a clear association between higher hospital volume and quality of BC care was not observed.
e827
CONCLUSIONS: Although rates are decreasing, these data suggest very high utilization rate of PBT at time of cystectomy in routine clinical practice. PBT is associated with substantially lower long-term survival. This association persists despite adjustment for provider volume, suggesting that PBT is a valid indicator of surgical care of bladder cancer.
Source of Funding: None Source of Funding: None
MP63-15
MP63-16
VALIDATION OF PERI-OPERATIVE BLOOD TRANSFUSION AS A SURGICAL QUALITY INDICATOR OF CYSTECTOMY: A POPULATION-BASED STUDY
UNPLANNED REOPERATION FOLLOWING OPEN AND MINIMALLY INVASIVE RADICAL CYSTECTOMY. ANALYSIS OF THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE.
D. Robert Siemens*, Melanie Jaeger, Xuejiao Wei, Francisco Vera-Badillo, Christopher Booth, Kingston, Canada
Ahmad Shabsigh*, Columbus, OH
INTRODUCTION AND OBJECTIVES: Previous single-center studies of peri-operative blood transfusion (PBT) at the time of radical cystectomy have suggested a potential association with longterm cancer survival. Here we describe the frequency of PBT at cystectomy in routine clinical practice and evaluate its effect on outcomes in order to explore its utility as a quality indicator of surgical care. METHODS: Electronic records of treatment and surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients with bladder cancer who underwent cystectomy and PBT between 2000-2008. Hospital discharge records identified PBT. Modified Poisson regression model was used to determine the factors associated with PBT. A Cox proportional hazards regression model was used to explore the association between PBT and overall (OS) and cancer-specific (CSS) survival. RESULTS: Among the 2593 patients with cystectomy in 20002008, 62% received an allogenic red blood cell transfusion. The frequency of PBT decreased over the study period (from 68% in 2000 to 54% in 2008, p<0.001). Factors associated with receiving PBT included age (80+ years RR 1.25, 95%CI 1.14-1.39), sex (female RR 1.40, 95% CI 1.33-1.48), greater co-morbidity (RR 1.11, 95%CI 1.03-1.20), T stage (T4 tumor RR 1.24, 95%CI 1.12-1.36) and surgeon volume (lowest quartile RR 1.18, 95%CI 1.08-1.28). Utilization of PBT was associated with inferior early outcomes including median length of stay (11 days vs 9 days, p<0.001), 90-day readmission rate (38% vs 29%, p<0.001) and 90-day mortality (11% vs 4%, p<0.001). OS (32% vs 47%, p<0.001) and CSS (38% vs 54%, p<0.001) at five years were lower among patients with PBT. These differences in long-term survival persisted on multivariate analysis (OS HR 1.33,95% CI 1.20-1.48; CSS HR 1.39, 95% CI 1.23-1.56).
INTRODUCTION AND OBJECTIVES: To define the rates and the predictors of unplanned reoperation (UR) following open (ORC) and minimally invasive radical cystectomy (MIRC) for bladder cancer. METHODS: We performed a retrospective review of prospectively collected database (NSQIP) of all patients who underwent open and minimally invasive radical cystectomy between 2005 and 2013. Patient’s demographics, unplanned reoperation rate and its causes were reported. Multivariate analysis was performed to characterize predictors of unplanned reoperation. RESULTS: Between 2005 and 2013, a total of 2279 cases were identified. 142 patients (6.2%) underwent unplanned reoperation within 30 days of cystectomy. Data regarding possible causes of reoperation was available for 2012 dataset. In 2012, 71 patients out of 1010 patients (7.0%) underwent reoperation following cystectomy. Wound dehiscence (27.9%), intestinal obstruction (22.1%), intestinal perforation (10.2%) and urinary anastmosis related complications (10.2%) were the most common causes of reoperation. Unplanned reoperation was lower in the MIRC group (2.2 % vs. 6.4 %), P¼ 0.06). Logistic regression analysis was performed to define the predictors of reoperation. In multivariate analysis disseminated cancer (OR 1.99, 95% CI 1.05-3.77, P¼ 0.03), preoperative dyspnea (OR 1.78, 95% CI 1.10-2.88, P¼ 0.01), male gender (OR 1.62, 95% CI 1.03-2.56, P0.04) and BMI (OR 1.05, 95% CI 1.02-1.08, P¼ 0.001) were independent risk factors of unplanned reoperation. CONCLUSIONS: Both ORC and MIRC have comparable outcomes regarding unplanned reoperation rates. Wound and bowel related complications are the major indications for unplanned reoperation following radical cystectomy. Source of Funding: Department Fundings