PD36-09 INSTITUTIONAL VOLUME IS ASSOCIATED WITH REDUCED 90 DAY MORTALITY RATES FOR BOTH OPEN AND ROBOTIC RADICAL CYSTECTOMY (2017)

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2017PD36-09 INSTITUTIONAL VOLUME IS ASSOCIATED WITH REDUCED 90 DAY MORTALITY RATES FOR BOTH OPEN AND ROBOTIC RADICAL CYSTECTOMY Kaitlin Kosinski, Melissa Fazzari, Michael Kongnyuy, Daniel Halpern, Marc Smaldone, Jeffrey Schiff, Aaron Katz, and Anthony Corcoran Kaitlin KosinskiKaitlin Kosinski More articles by this author , Melissa FazzariMelissa Fazzari More articles by this author , Michael KongnyuyMichael Kongnyuy More articles by this author , Daniel HalpernDaniel Halpern More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Jeffrey SchiffJeffrey Schiff More articles by this author , Aaron KatzAaron Katz More articles by this author , and Anthony CorcoranAnthony Corcoran More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1558AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Perioperative mortality and readmission rates are evolving metrics of care being monitored in radical cystectomies (RC). We aim to evaluate these outcomes in open radical cystectomies (ORC) and robotic assisted radical cystectomies (RARC) reported in the National Cancer Data Base adjusted by surgery type. METHODS Using the National Cancer Data Base, patients treated with RC from 2003 to 2010 were identified. We evaluated the association between 90-day conditional mortality and readmission with respect to surgery type, adjusted by patient (age, gender, race/ethnicity, Charlson-Deyo score, tumor type, clinical stage, margin status and receipt of neoadjuvant chemo-or radiotherapy) and facility characteristics (overall cystectomy volume and facility type [Academic/Research, Comprehensive Community, or other]). RESULTS 16,923 RC cases (13,236 ORC, 3,687 RARC) were identified with 480 deaths (3.6%) after ORC and 99 deaths (2.7%) after RARC within 90 days, conditional upon surviving 30 days post-surgery. Comparing <3 cystectomies/year to >20 cystectomies/year, 90-day overall conditional mortality rates decreased from 4.0% to 2.5%. In stratified analyses, 90-day conditional mortality rates decreased from 4.2% to 2.7% for ORC and 2.7% to 2.0% for RARC. Center volume was strongly associated with 90-day conditional survival (p=0.002), independent of surgery type. In multivariable analysis of 90-day conditional mortality, age (OR=1.03, 95% CI: 1.02-1.04, p<0.0001), comorbidites (OR=1.4, 95% CI: 1.12-1.6, p=0.0005), margin rates (OR=3.5,95% CI: 2.9-4.3, p<0.0001) as well as facility volume (OR=0.99, 95% CI: 0.98-1.00, p=0.001), were predictive of 90-day conditional mortality. Cystectomy volume did not predict 30 day readmission, however, Charlson-Deyo score 1-2 (OR=1.274, 1.112-1.461 95% CI, p=0.0005) and receipt of neoadjuvant chemo- or radiotherapy (OR=1.161, 1.032-1.307 95% CI, p=0.0134) were significantly associated with 30-day readmission. CONCLUSIONS Patients were less likely to incur death following robotic or open cystectomy within 90 days as institutional cystectomy volume increased. 30 day readmission rates were not influenced by institutional cystectomy volume. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e672 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kaitlin Kosinski More articles by this author Melissa Fazzari More articles by this author Michael Kongnyuy More articles by this author Daniel Halpern More articles by this author Marc Smaldone More articles by this author Jeffrey Schiff More articles by this author Aaron Katz More articles by this author Anthony Corcoran More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...