Presentation Authors: Alejandro Abello*, Jamil Syed, Michael Leapman, Patrick A. Kenney, New Haven, CT
Introduction: Patients value hospital rankings when making decisions about their healthcare. Rankings, such as the US News and World Report (USNWR) integrate safety, outcome, and reputation metrics, however it is unknown whether these rankings are robust to surgery type, or if meaningful differences exist within top performing strata. Therefore, we aimed to study the associations of USNWR ranking and outcome measures using national registry data
Methods: We used the Vizient CDB a hospital registry representing care at 97% of academic centers to analyze outcomes for urologic surgeries from 2014 through 2018. We compiled the following hospital outcomes on mortality, length of stay (LOS), 30-day readmissions, LOS index (observed/expected ratios), case mix index and patient safety and adverse event composite (PSI-90) for radical prostatectomy (RP), cystectomy (RC) and radical nephrectomy (RN). We studied the associations of USNWR &[Prime]Top 50 Hospitals&[Prime] and outcome by surgery type and in aggregate.
Results: We identified 20,888 cases including 8,385 RP, 7,486 RN and 5,017 RC during the study period. Case volume was significantly higher in top 10 hospitals for RP, RC, and RN compared to 11-20 that was the second group with highest volume (1,700 more cases for RP, 1,806 for RN and 490 for RC; P < 0.001). Hospital LOS was significantly lower in the upper quintile for RP (P < 0.001) and RN (P < 0.001) but not in RC. Adjusting for expected ratios, LOS index was similar in RP among the different quintiles but was lower for RN. 30-day readmission in upper quintile was significantly lower in RP only compared to 41-50 but similar to 11-40 institutions There was not significant variation in mortality between groups or procedures. Bottom ranking positions were negatively correlated with surgical volume (RP rho: -0.50, P < 0.001; RN rho -0.41, P 0.005; RC rho: -0.42, P 0.0013) and positively correlated with mean LOS for RP (rho 0.45, P 0.002) and RC (rho 0.48, P 0.001). No other significant differences were found for the other variables. Comparing outcomes individually by hospitals, no significant differences or trends were found favoring top hospitals for LOS, mortality, costs, readmissions or PSI-90
Conclusions: USNWR ranking of top urology programs was associated with better measures of patient outcome including mortality, readmission, and length of stay when grouped by quintiles and remained consistent across major cancer surgery types. There were no significant differences in outcome within deciles of rank, suggesting that categories of performance rather than ordinal position may be sufficient to describe hospital quality