Best of AUA 2014: Outcomes Analysis

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• An examination of the effect of self-referral on the utilization of CT scans and treatment protocols found that providers who had the highest levels of self-referral for CT scanning did have higher levels of CT scan utilization. But researchers also noted an association with increased utilization of extracorporeal shock wave lithotriopsy (ESWL), speculating that ownership interest of a CT scanner is often associated with ownership interest in an ESWL machine.

• Despite evidence-based AUA guidelines on peri-procedural antibiotic prophylaxis for transrectal ultrasound-guided (TRUS) prostate biopsies, not all patients receive guideline-concordant antibiotics. In a Michigan registry, in patients who received non-compliant antibiotics, the 30-day complication rate for urinary tract infections was 3.8%, substantially higher than in patients who received guideline-concordant antibiotics.

• In an examination of fluoroquinolone resistance in rectal swabs performed prior to TRUS biopsy, 20.5% of patients had fluoroquinolone resistance. In those with fluoroquinolone resistance, the infectious complication rate was 6.6% and the hospitalization rate was 4.4%, substantially higher than among those without fluoroquinolone resistance.

• Switching from a standard protocol of 3 days of peri-procedural fluoroquinolones prior to TRUS biopsy to a modified protocol (prophylaxis with single-dose ceftriaxone or gentamicin plus a single dose of oral fluoroquinolone) led to a drop in infectious complication rate from 6.1% to 2.2% at one institution.

• Using a Markov model of three treatment strategies for muscle-invasive bladder cancer-monotherapy with radical cystectomy, neoadjuvant chemotherapy plus radical cystectomy, and radiation therapy (RT) plus chemotherapy plus cystectomy (if no remission)-overall life expectancy was highest in the neoadjuvant chemotherapy plus cystectomy group at 9.6 years. However, the cohort with the greatest quality-adjusted life expectancy was the group receiving RT plus chemo with or without cystectomy.

• Pediatric urologists instituting a telehealth system were able to reduce the number of families with appointment wait times of >29 days from 53.5% to 37.5%.

• While Canadian guidelines for patient health information recommend that this information be written at a fourth- to sixth-grade reading level, one group’s information was written above the eighth-grade reading level. Separately, patient health information from Google, Bing, and Yahoo was at the eleventh-grade reading level on average.

• Although most quality improvement measures aimed at reducing rates of overutilization in CT for low-risk prostate cancer examine individual provider practices, researchers noted a substantial correlation by region among providers who were overprescribing or overusing CT scans for prostate as well as breast cancer.

• Using a composite model of five nationally endorsed quality metrics, study authors found no consistent association between health care system quality and outcomes, raising questions about the validity of using a process-oriented quality matrix to address differences in quality of care between health systems.

• Instrumental variable analysis was used to adjust for both known and unknown patient confounders when examining robotic and open radical prostatectomy outcomes. Rates of complications and additional cancer therapies were comparable, but robotic surgery had lower odds of transfusion, lower odds of prolonged length of stay, and increased cost.UT

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