To examine hospital-level variation in outcomes following benign urologic surgeries given that hospital level variation in surgical outcomes can portend quality and appropriateness of care concerns and identify quality improvement opportunities in perioperative care.
Using the Washington State Comprehensive Hospital Abstract Reporting System (CHARS), we identified patients that underwent transurethral resection of the prostate (TURP), percutaneous nephrostolithotomy (PCNL), and pyeloplasty from 2003-2008. We classified prolonged postoperative length of stay (LOS) as that exceeding the 75(th) percentile, and we measured the rate of Agency for Healthcare Quality Patient Safety Indicators (PSIs), readmissions, and death. We calculated hospital-specific observed-to-expected event rates using random effects multilevel multivariable models adjusted for age and comorbidity.
We identified 6,699 TURP patients at 54 different hospitals, 2,541 PCNL patients at 45 hospitals, and 584 pyeloplasty patients at 36 hospitals. Complication rates were highest after PCNL (22.9% prolonged LOS vs. 17.3% for TURP and 13.9% for pyeloplasty, p<0.001; 3.4% 90-day mortality vs. 0.6% for TURP and 0% for pyeloplasty). Hospital-level variation was most substantial for LOS after TURP and pyeloplasty (8.1% and 14.3% of variance in prolonged LOS, respectively).
Hospital-level variation is common after benign inpatient urologic surgeries and may relate to difference in perioperative provider practice patterns. The morbidity of PCNL in this study was higher than expected and merits further investigation.
Pharmacology, Toxicology and Pharmaceutical Science
2
6%
Nursing and Health Professions
2
6%
Arts and Humanities
1
3%
Unspecified
1
3%
Other
4
13%
Unknown
14
45%
Attention Score in Context
Attention Score in Context
This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 15 November 2015.
All research outputs
#7,301,979
of 25,373,627 outputs
Outputs from Urology
#2,507
of 7,811 outputs
Outputs of similar age
#85,098
of 295,218 outputs
Outputs of similar age from Urology
#31
of 145 outputs
Altmetric has tracked 25,373,627 research outputs across all sources so far. This one has received more attention than most of these and is in the 71st percentile.
So far Altmetric has tracked 7,811 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.5. This one has gotten more attention than average, scoring higher than 67% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 295,218 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 71% of its contemporaries.
We're also able to compare this research output to 145 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 77% of its contemporaries.
