Khawaja Bilal

Utilization Trends and Short-term Outcomes of Robotic Versus Open Radical Cystectomy for Bladder Cancer

OBJECTIVE To compare utilization trends and short-term outcomes of robotic versus open radical cystectomy for bladder cancer since the introduction of the robotic modifier (ICD-9 17.4x). MATERIALS AND METHODS Using the Statewide Planning and Research Cooperative System database, an all-payer administrative system on all hospital discharges in New York State, we identified patients undergoing radical cystectomy (57.71) with a diagnosis of bladder cancer (188.0-188.9, 233.7, 236.7) from October 2008 to December 2012. Primary outcomes were inpatient complications and mortality at index stay. RESULTS Of the 2525 patients, 24.2% (610 of 2525) underwent robotic and 75.8% (1915 of 2525) underwent open radical cystectomy. The proportion of robotic cases increased from 19.9% (119 of 597) in 2009 to 28.9% (173 of 598) in 2012 (P < .05). From 2009 to 2012, the number of open surgeons decreased from 117 to 109, and that of robotic increased from 56 to 66. Robotic patients had lower approach-specific surgeon and hospital volume, and more likely underwent lymph node dissection, ileal conduit diversion, blood transfusion, and prolonged length of stay. On multivariate analysis, robotic approach conferred a reduced risk of blood transfusion (odds ratio: 0.600, 95% confidence interval: 0.492-0.732, P < .0005) but had no association with prolonged length of stay. There were no significant differences in inpatient complications or mortality at index stay, parenteral nutrition, length of stay, hospital charges, readmission rates up to 90 days, or mortality up to 90 days between the surgical approaches. CONCLUSION Despite the rapid dissemination and more recent experience of robotic radical cystectomy, we report lower rates of blood transfusion and otherwise similar short-term outcomes with open radical cystectomy.

Trends in Subspecialization Within Inpatient Urology From 1982 to 2012.

OBJECTIVE To elucidate the evolving trends in subspecialization related to individual practice within inpatient urology over a 31-year period spanning from 1982 to 2012. METHODS We conducted a retrospective cohort study by querying the centralized New York State data on partial nephrectomy, radical nephrectomy, radical prostatectomy, and radical cystectomy procedures for all inpatient encounters in the state of New York for the years 1982-2012 using the Statewide Planning and Research Cooperative System dataset. All encounters involving 1 of the procedures were identified and the AMA Masterfile was used to identify all physicians who have completed residencies in urology. We performed descriptive analyses to determine the quantity of cases, quantity of patients, and distribution of the cases among operating physicians. High-volume urologists, defined as the top 5% of urologists in terms of caseload, were identified, and the distributions of their procedures was analyzed. RESULTS The proportion of procedures completed by high-volume urologists increased significantly for all procedures. The number of identified urologists involved in radical cystectomy and radical nephrectomy has declined since 1982, with the number of identified urologists involved in partial nephrectomy and radical prostatectomy beginning a continuous decline from 2004 to 1999, respectively. During the 31-year time period, the number of cases increased for all procedures. CONCLUSION A smaller group of urologists is performing a larger proportion of cases for each studied procedure, reflecting a trend toward subspecialization.