Vol. 191, No. 4S, Supplement, Friday, May 16, 2014 THE JOURNAL OF UROLOGY� e15

General & Epidemiological Trends &Socioeconomics: Evidence-based Medicine &

Outcomes I

Podium

Friday, May 16, 2014 1:00 PM-3:00 PM

PD2-01INFECTION-RELATED HOSPITALIZATIONS AFTER PROSTATEBIOPSY IN A STATE-WIDE QUALITY IMPROVEMENTCOLLABORATIVE

Paul R. Womble, MD*, Maxwell W. Dixon, BS, Susan M. Linsell, MHSA,Zaojun Ye, MS, James E. Montie, MD, Ann Arbor, MI;Brian R. Lane, MD, PhD, Grand Rapids, MI; David C. Miller, MD, MPH,Ann Arbor, MI; Fank N. Burks, MD, Royal Oaks, MI

INTRODUCTION AND OBJECTIVES: While transrectal pros-tate biopsy is the cornerstone of prostate cancer diagnosis, seriouspost-biopsy infectious complications are reported to be increasing. Abetter understanding of the true prevalence and microbiology of theseevents is needed to guide quality improvement in this area and ulti-mately better early detection practices.

METHODS: Using data from the Michigan Urological SurgeryImprovement Collaborative (MUSIC) registry, we identified all menwho underwent transrectal prostate biopsy at 21 practices in Michiganfrom March 2012 through June 2013. Trained data abstractorsrecorded pertinent data, including prophylactic antibiotics and allbiopsy-related hospitalizations within 30 days of the procedures. For asubset of patients, claims data and follow-up telephone calls wereutilized for validation. All men admitted for an infectious complicationwere identified and their culture data obtained. We then compared thefrequency of infection-related hospitalization rates across practicesand according to antibiotic prophylaxis in concordance with AUA bestpractice recommendations.

RESULTS: The overall 30-day hospital admission rate followingprostate biopsy was 0.97%, ranging from 0% to 4.2% across 21 MUSICpractices (Figure). Ninety-five percent of admissions were for infectiouscomplications; the majority of cultures identified fluoroquinolone-resis-tant organisms. AUA concordant antibiotics were administered in 96.3%of biopsies. Patients receiving noncompliant antibiotic regimens weresignificantly more likely to be hospitalized for infectious complications(3.8% vs. 0.89%, p ¼ 0.0026).

CONCLUSIONS: Infection-related hospitalizations occur inapproximately 1% of men undergoing prostate biopsy in Michigan. Ourfindings suggest that many of these events could be avoided byimplementing new protocols (e.g., culture-specific or augmented anti-biotic prophylaxis) that both adhere with AUA best practice recom-mendations and address fluoroquinolone resistance.

Source of Funding: Blue Cross Blue Shield of Michigan

PD2-02QUALITY IMPROVEMENT OPPORTUNITIES IN PROSTATECTOMYCARE IN A REGIONAL HOSPITAL-BASED UROLOGIC QUALITYCOLLABORATIVE

John L. Gore*, Michael Porter, John Corman, Seattle, WA;Douglas Sutherland, Tacoma, WA; Zeila Schmidt, David Flum,Seattle, WA

INTRODUCTION AND OBJECTIVES: Prostate cancer careis susceptible to regional variation in selection for treatment and out-comes after primary therapy. Recent national recommendations havehighlighted the harms of prostate cancer treatment including urinaryincontinence and erectile dysfunction. We prospectively evaluatedradical prostatectomy (RP) outcomes at participating Washington-statehospitals to identify quality improvement opportunities in RP care.

METHODS: We convened a clinician advisory group of localurologists engaged in prostate cancer care to develop a chartabstraction tool that captures potential quality concerns in RP care. Theabstraction tool was implemented at nine regional hospitals with dataconsolidated for review quarterly. The research team and clinicianadvisory group were blinded to the hospital identities in hospital-specificfeedback reports. Data were analyzed as aggregate rates and hospital-specific rates without risk adjustment using descriptive statistics.

RESULTS: We abstracted data on 461 patients undergoing RPat 9 area hospitals from 2011-2013. The majority were robot-assistedminimally invasive RPs (344/461, 74%), Participating hospitals report asmany as 97% or as few as 12% robot-assisted procedures. 26.3% ofcases were pathologic non-organ-confined prostate cancer (pT3 orhigher); pathologic stage was not further classified beyond "T2" or "T3" in31% of RPs. Surgical margins were positive in 18% of cases overall;hospital-specificpositivemargin rates ranged from12-25%amongorgan-confined cases and 0-75% among stage pT3 or higher prostate cancer.Lymphadenectomy was performed in 53-100% of RPs by hospital forintermediate and high-risk cancer cases. Length of stay exceeded threedays post-prostatectomy in more than 10% of cases at 4 hospitalsincluding one hospital where 36%of cases had prolonged lengths of stay.

CONCLUSIONS: We identified several quality improvementopportunities that may improve health outcomes among men undergoingRP for prostate cancer. Positive margin rates were excessive at somehospitals andmay represent uncertainty in the surgical approach to higherrisk cases. Variation in lengths of stay may represent provider variation inpost-prostatectomy clinical care algorithms. Survey of provider practicesmay inform development of quality improvement initiatives such as clinicalpathways that may address the variations in RP care identified.

Source of Funding: This work was supported by funding fromthe National Cancer Institute, the Agency of HealthcareResearch and Quality, and the Life Sciences Discovery Fund.

PD2-03IDENTIFICATION OF QUALITY IMPROVEMENT OPPORTUNITIESIN KIDNEY CANCER SURGERY THROUGH A REGIONALHOSPITAL-BASED UROLOGIC QUALITY COLLABORATIVE

John L. Gore*, Michael Porter, Danlel Lin, Jonathan Harper,Zeila Schmidt, David Flum, Seattle, WA

INTRODUCTION AND OBJECTIVES: Patient selection forradical (RN) and partial nephrectomy (PN) for suspicion of kidneycancer may depend more on provider factors than patient characteris-tics or cancer severity. National cancer registry data suggests thatpatients with small renal tumors have better overall survival whenmanaged with PN rather than RN. We prospectively evaluated periop-erative processes of care for patients undergoing kidney cancer surgeryat Washington State hospitals participating in a surgical collaborative toidentify quality improvement opportunities in kidney cancer care.

METHODS: We developed a chart abstraction tool that cap-tures potential quality concerns in kidney cancer surgical care. Theabstraction tool was implemented at nine regional hospitals with data