Patel Hiten D, Ball Mark W, Cohen Jason E, Kates Max, Pierorazio Phillip M, Allaf Mohamad E
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Urology. 2015 Mar;85(3):552-9. doi: 10.1016/j.urology.2014.11.034.
To quantify national complication rates, perioperative outcomes, and predictors for a broad range of urologic procedures to demonstrate background rates and discuss benchmarking.
Urologic procedures from the National Surgical Quality Improvement Program (2006-2011) were analyzed to identify 30-day rates of 21 complications; outcomes (length of stay, reoperation, and death); and predictors including resident involvement for 18 specific procedures. Multivariate logistic regression models assessed predictors for any complication and for Clavien grade IV or V complication.
A total of 39,700 procedures were included with abdominopelvic operations more morbid than endoscopic, scrotal, incontinence, or prolapse procedures. Cystectomy had the highest morbidity (10.8 days length of stay and 3.2% mortality), with 56% experiencing any complication followed by nephrectomy (21%), retroperitoneal lymph node dissection (20%), and radical retropubic prostatectomy (19%). Transurethral resection of bladder tumor (11%) and transurethral resection of the prostate (10%) had the highest rates for endoscopic procedures. Older age, American Society of Anesthesiologists class, dependent functional status, acute kidney injury (odds ratio [OR], 2.70 [1.89-3.87]), and ≥5 units preoperative transfusion (OR, 4.44 [3.40-5.80]) were the strongest predictors of any complication. Higher ORs of similar predictors along with chronic obstructive pulmonary disorder (OR, 1.52 [1.21-1.92]) and steroid use (OR, 1.51 [1.07-2.14]) were associated with Clavien grade IV or V complication. Resident involvement increased odds of any complication (OR, 1.18 [1.09-1.29]), mostly for abdominopelvic and urogynecologic procedures, but not Clavien grade IV or V complication (P = .55).
Complication rates of urologic procedures based on the retrospective experience of few surgeons do not allow for appropriate benchmarking. Baseline rates and benchmarks derived from the National Surgical Quality Improvement Program may help hospitals better track deficient areas and improvements in quality of care. Many predictors were similar across procedures, although magnitudes differed, and resident trainees did not impact rates of serious complications (Clavien-Dindo grade IV or V).
量化一系列泌尿外科手术的全国并发症发生率、围手术期结局及预测因素，以展示背景发生率并探讨基准指标。
分析国家外科质量改进计划（2006 - 2011年）中的泌尿外科手术，以确定21种并发症的30天发生率；结局指标（住院时间、再次手术和死亡）；以及18种特定手术的预测因素，包括住院医师参与情况。多因素逻辑回归模型评估任何并发症以及Clavien IV级或V级并发症的预测因素。
共纳入39700例手术，腹部盆腔手术比内镜、阴囊、尿失禁或脱垂手术的并发症更多。膀胱切除术的发病率最高（住院时间10.8天，死亡率3.2%），56%的患者发生任何并发症，其次是肾切除术（21%）、腹膜后淋巴结清扫术（20%）和耻骨后前列腺根治术（19%）。经尿道膀胱肿瘤切除术（11%）和经尿道前列腺切除术（10%）在内镜手术中发生率最高。年龄较大、美国麻醉医师协会分级、依赖性功能状态、急性肾损伤（比值比[OR]，2.70[1.89 - 3.87]）以及术前输血≥5单位（OR，4.44[3.40 - 5.80]）是任何并发症的最强预测因素。类似预测因素的较高OR值以及慢性阻塞性肺疾病（OR，1.52[1.21 - 1.92]）和使用类固醇（OR，1.51[1.07 - 2.14]）与Clavien IV级或V级并发症相关。住院医师参与增加了任何并发症的发生几率（OR，1.18[1.09 - 1.29]），主要是腹部盆腔和泌尿妇科手术，但与Clavien IV级或V级并发症无关（P = 0.55）。
基于少数外科医生的回顾性经验得出的泌尿外科手术并发症发生率无法进行适当的基准对比。来自国家外科质量改进计划的基线发生率和基准指标可能有助于医院更好地追踪不足之处并改善医疗质量。尽管程度不同，但许多预测因素在不同手术中相似，住院医师培训并未影响严重并发症（Clavien - Dindo IV级或V级）的发生率。
