Please use this identifier to cite or link to this item: https://hdl.handle.net/10356/164050
Title: Defining factors associated with high-quality surgery following radical cystectomy: analysis of the British Association of Urological Surgeons cystectomy audit
Authors: Tan, Wei Shen
Leow, Jeffrey J.
Marchese, Maya
Sridhar, Ashwin
Hellawell, Giles
Mossanen, Matthew
Teoh, Jeremy Y. C.
Fowler, Sarah
Colquhoun, Alexandra J.
Cresswell, Jo
Catto, James W. F.
Trinh, Quoc-Dien
Kelly, John D.
Keywords: Science::Medicine
Issue Date: 2021
Source: Tan, W. S., Leow, J. J., Marchese, M., Sridhar, A., Hellawell, G., Mossanen, M., Teoh, J. Y. C., Fowler, S., Colquhoun, A. J., Cresswell, J., Catto, J. W. F., Trinh, Q. & Kelly, J. D. (2021). Defining factors associated with high-quality surgery following radical cystectomy: analysis of the British Association of Urological Surgeons cystectomy audit. European Urology Open Science, 33, 1-10. https://dx.doi.org/10.1016/j.euros.2021.08.005
Journal: European Urology Open Science
Abstract: Background: Radical cystectomy (RC) is associated with high morbidity. Objective: To evaluate healthcare and surgical factors associated with high-quality RC surgery. Design, setting, and participants: Patients within the prospective British Association of Urological Surgeons (BAUS) registry between 2014 and 2017 were included in this study. Outcome measurements and statistical analysis: High-quality surgery was defined using pathological (absence of positive surgical margins and a minimum of a level I lymph node dissection template with a minimum yield of ten or more lymph nodes), recovery (length of stay ≤10 d), and technical (intraoperative blood loss <500 ml for open and <300 ml for minimally invasive RC) variables. A multilevel hierarchical mixed-effect logistic regression model was utilised to determine the factors associated with the receipt of high-quality surgery and index admission mortality. Results and limitations: A total of 4654 patients with a median age of 70.0 yr underwent RC by 152 surgeons at 78 UK hospitals. The median surgeon and hospital operating volumes were 23.0 and 47.0 cases, respectively. A total of 914 patients (19.6%) received high-quality surgery. The minimum annual surgeon volume and hospital volume of ≥20 RCs/surgeon/yr and ≥68 RCs/hospital/yr, respectively, were the thresholds determined to achieve better rates of high-quality RC. The mixed-effect logistic regression model found that recent surgery (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.11–1.34, p < 0.001), laparoscopic/robotic RC (OR: 1.85, 95% CI: 1.45–2.37, p < 0.001), and higher annual surgeon operating volume (23.1–33.0 cases [OR: 1.54, 95% CI: 1.16–2.05, p = 0.003]; ≥33.1 cases [OR: 1.64, 95% CI: 1.18–2.29, p = 0.003]) were independently associated with high-quality surgery. High-quality surgery was an independent predictor of lower index admission mortality (OR: 0.38, 95% CI: 0.16–0.87, p = 0.021). Conclusions: We report that annual surgeon operating volume and use of minimally invasive RC were predictors of high-quality surgery. Patients receiving high-quality surgery were independently associated with lower index admission mortality. Our results support the role of centralisation of complex oncology and implementation of a quality assurance programme to improve the delivery of care. Patient summary: In this registry study of patients treated with surgical excision of the urinary bladder for bladder cancer, we report that patients treated by a surgeon with a higher annual operative volume and a minimally invasive approach were associated with the receipt of high-quality surgery. Patients treated with high-quality surgery were more likely to be discharged alive following surgery.
URI: https://hdl.handle.net/10356/164050
ISSN: 2666-1683
DOI: 10.1016/j.euros.2021.08.005
Rights: © 2021 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Fulltext Permission: open
Fulltext Availability: With Fulltext
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