Barbieri Christopher E, Lee Byron, Cookson Michael S, Bingham John, Clark Peter E, Smith Joseph A, Chang Sam S
Department of Urologic Surgery and Center for Clinical Improvement, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA.
J Urol. 2007 Oct;178(4 Pt 1):1418-21; discussion 1421-2. doi: 10.1016/j.juro.2007.05.156. Epub 2007 Aug 16.
Studies of national databases yield important information about expected outcomes after radical cystectomy and factors that influence patient morbidity and mortality. We examined the hospital characteristics associated with outcomes after radical cystectomy in a cohort study using results from a single, high volume academic institution as well as a nationwide data set of academic institutions.
We obtained data from the University HealthSystem Consortium Clinical Database on 6,728 patients nationwide who underwent radical cystectomy for bladder cancer between 2002 and 2005 as well as on 421 who underwent cystectomy at our institution during this period. Outcomes were compared by hospital characteristics (geographic location, total hospital discharges and procedure volume). The outcome measures analyzed were length of hospital stay, the complication rate and in hospital mortality.
The overall complication rate at our institution was 32.07% with an in hospital mortality rate of 0.95% and an average length of stay of 7.05 days. The overall complication rate in the University HealthSystem Consortium data set was 37.16% with an in hospital mortality rate of 1.47% and an average length of stay of 10.98 days. Institutions with higher cystectomy volumes had significantly better outcomes than institutions with lower procedure volumes. The mortality rate at institutions with greater than 50 cystectomies per year was 0.54% compared to 2.70% at institutions with 10 or fewer per year (p <0.0005). Outcomes varied only minimally with total hospital discharges or geographic region.
Even among academic medical centers hospitals with a higher volume of cystectomies in 2002 to 2005 were associated with improved outcomes, including decreased mortality, shorter length of stay and lower rehospitalization rates. These data may provide a framework for self-assessment and help establish criteria for performance evaluation.
对国家数据库的研究可得出关于根治性膀胱切除术后预期结果以及影响患者发病率和死亡率因素的重要信息。我们在一项队列研究中，利用来自一家高容量学术机构的结果以及全国学术机构数据集，研究了与根治性膀胱切除术后结果相关的医院特征。
我们从大学卫生系统联盟临床数据库获取了2002年至2005年间全国6728例因膀胱癌接受根治性膀胱切除术患者的数据，以及同期在我们机构接受膀胱切除术的421例患者的数据。根据医院特征（地理位置、医院总出院人数和手术量）对结果进行比较。分析的结果指标包括住院时间、并发症发生率和住院死亡率。
我们机构的总体并发症发生率为32.07%，住院死亡率为0.95%，平均住院时间为7.05天。大学卫生系统联盟数据集中的总体并发症发生率为37.16%，住院死亡率为1.47%，平均住院时间为10.98天。膀胱切除量较高的机构的结果明显优于手术量较低的机构。每年进行超过50例膀胱切除术的机构的死亡率为0.54%，而每年进行10例或更少膀胱切除术的机构的死亡率为2.70%（p<0.0005）。结果仅随医院总出院人数或地理区域有极小的变化。
即使在学术医疗中心中，2002年至2005年膀胱切除量较高的医院与更好的结果相关，包括死亡率降低、住院时间缩短和再住院率降低。这些数据可为自我评估提供框架，并有助于建立绩效评估标准。
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