Brent K Hollenbeck

..We studied the influence of socioeconomic status and race on use of ASCs...

..We sought to elicit the influence of local pressures (in the form of the technologic imperative exerted by laparoscopy) on discharge physician practice style as measured by LOS...

..We determined the extent to which the regionalization of nephrectomy has occurred and describe the potential causes and implications of any observed regionalization...

..From a quality-of-care perspective, the underuse of partial nephrectomy may represent suboptimal delivery of healthcare...

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..Although screening currently is not recommended, better medical care of patients who are at risk (ie, those with hematuria) has the potential to improve outcomes...

..Characterization of these factors could enhance preoperative patient counseling and facilitate perioperative management, thereby improving the quality of patient care...

..Alternatively, black patients may receive a lower quality of care, which may explain this difference...

..We sought to measure the impact of both case mix and physician practice (perioperative process/risk factors) on length of stay (LOS)-a common benchmark- after laparoscopic surgery...

..Mounting evidence suggests a relationship between hospital volume and outcomes after major cancer surgery; however, the absolute benefits of volume-based referral on a national basis are unclear...

..However, the processes of care that mediate this effect are unknown. We sought to identify the processes that underlie the volume-outcome relationship for cystectomy...

..To better understand the relationships between case-mix, processes of care, and recovery after laparoscopic surgery...

..Investigators should be cognizant of this bias and exercise caution when interpreting these relationships when using SEER-Medicare data alone...

..Despite growing calls for using lymph node counts as a hospital quality indicator, it has not been established that hospitals that obtain more lymph node have better outcomes...

..To develop a generic instrument for measuring short-term health status in the recovery period among patients undergoing abdominal and pelvic surgery...

..Finally, we provide a framework for future research by presenting an overview of recent work pertaining to cystectomy and quality of care...

..We examined associations between initial treatment intensity and subsequent outcomes...

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..From a quality of care perspective, overuse of partial cystectomy may signify inappropriate delivery of health care...

..The implications of stage divergence on survival are ill defined in the context of those treated by surgery alone and would facilitate patient counseling and enhance prognostication...

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..We use a tailored approach to laparoscopic partial nephrectomy based on tumor depth of penetration and proximity to the renal sinus. We evaluated differences in perioperative outcomes to determine the value of this paradigm...

..In this review, we discuss the broad concepts of health care quality and describe their relationships with small renal tumors...

..This study compared oncologic and health-related quality-of-life outcomes among patients undergoing intraperitoneal or extraperitoneal robotic prostatectomy...

..The authors performed a study to prospectively assess relationships between intraoperative processes and early functional recovery after surgery...

..Restaging bladder tumor resection improves staging accuracy and the response to intravesical therapy. However, its use outside of a tertiary care setting, and its subsequent clinical implications, are unknown...

..Thus, Medicare's transplant experience allows us to examine the role of payer leverage in motivating hospital benchmark compliance...

..Risk adjustment tools should be used to identify patients (young and old) who would be better served by less aggressive management...

..The National Quality Forum and other organizations recently endorsed a 12-node minimum as a measure of hospital quality...

..We report our experience with hand assisted laparoscopic (HALS) nephroureterectomy and describe the associations of preoperative, operative and pathological factors with outcome...

..For this reason, the relative importance of broadening indications for aggressive therapy has unclear implications...

..Despite these findings obese patients should not be dissuaded from considering prostatectomy as definitive treatment for localized prostate cancer...

..To better understand associations between managed care penetration in health care markets and the adoption of intensity-modulated radiotherapy (IMRT)...

..We studied the relationship between certificate of need laws and market level adoption of robotic prostatectomy...

..CONCLUSIONS: These data quantify a target population for whom greater use of expectant approaches may reduce overtreatment and improve the quality of localized prostate cancer care...

..To evaluate the relationship between ownership and use of ambulatory surgical centers (ASCs)...

..We developed and validated a reliable, responsive multidimensional instrument to measure disease specific health related quality of life in bladder cancer survivors treated with local cancer therapy...

..To study the evolution of surgical margins in robotic prostatectomy (DVP), to ascertain the surgical volume necessary to provide quality cancer care...

..Therefore, we determined whether payments for outpatient surgery vary by location of care...

..We examined associations between hospital stay and short-term outcomes for a low risk procedure (prostatectomy) and high risk procedure (cystectomy)...

..As health care delivery reforms gain traction, policy makers must balance the promotion of new, yet unproven, technology with the risk of overuse...

..To understand how physician ownership of ambulatory surgery centers (ASCs) relates to surgery use...

..For this reason, we undertook a study to better understand the relationships between large prostate size and robotic prostatectomy outcomes with respect to intraoperative and pathologic factors...

..During this period short-term outcomes following cystectomy improved, while the use of subacute care facilities and home health services increased dramatically, underscoring a shift in the burden of care in this patient population...

..Despite their potential benefits to patients, the adoption of partial nephrectomy and laparoscopic kidney cancer surgery has been both gradual and concentrated in select hospitals...

..Urologists who acquired partnership shares were incentivized to perform shock wave lithotripsy preferentially over URS. Because of ownership expansion, the rates of URS might have decreased...

..Practice guidelines for nonmuscle invasive (ie, early stage) bladder cancer are ambiguous, resulting in substantial practice variation without a clear patient benefit...

..9 per 1000 population; P < .01). The presence of an ASC is associated with higher utilization of common outpatient procedures in the elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear...

..The impact of this increasing burden of care on tertiary centers is unclear but may be problematic in the current reimbursement environment...

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..We evaluated the impact of the specialized medical and ancillary services available at low vs. high volume prostatectomy centers on prolonged length of stay (LOS) outcomes after radical prostatectomy...

..Additional study using detailed clinical data is necessary to identify the underlying causes of these differences...

..Early stage bladder cancer is a heterogeneous disease with a variable risk of progression and mortality. Uncertainty surrounding the optimal care for these patients may result in a mismatch between disease risk and treatment intensity...

..For this reason, a multilevel analysis was conducted using a population-based cohort to evaluate the amount of variation in laparoscopic donor nephrectomy use attributable to the individual, provider, and hospital levels...

..Therefore, we compared the use of laparoscopy by procedure indication (kidney donor, and benign and malignant kidney disease) to examine potential specialty specific associations with the slow uptake of this technology...

..The histologic classification of kidney cancer has been revised to reflect this new paradigm...

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..The fact that increased detection and treatment of small tumors is not reducing mortality argues for a reassessment of the current treatment paradigm...

..Weekend hospital admission is associated with different and poorer quality care in certain clinical settings...

..The risk is proportional to the number of renal units treated and may be assumed at once (e.g., same-session) or over time (e.g., staged) as it applies to patients requiring bilateral ureteroscopy...

..Motivated by these concerns we evaluated how opening of an ambulatory surgery center impacts stone surgery use in a health care market and assessed the effect of its opening on the patient mix at nearby hospitals...

..To this end, urologic professional societies and their surgeons should aim to identify underwriters for and participate in large clinical registries and surgical quality collaboratives...

..Stratifying patient reported sexual function by the principal determinants of age, nerve sparing and prostate size provides a basis for counseling patients...

..To prospectively compare the relevant in-hospital and postdischarge short-term health outcomes in a contemporary group of patients undergoing either robotic or conventional radical prostatectomy...

..To better understand the associations between the certificate of need regulations and intensity-modulated radiotherapy dissemination...

..To better understand the barriers to the dissemination of medical expulsive therapy we analyzed health care claims of working age adults with urinary stone disease...

..As a result, survivors have a protracted course, harboring considerable clinical and economic implications. Thus, we investigated the extent to which health service use and expenditures vary during continuing prostate cancer care...

..Growth in prostate cancer spending continues to outpace that for overall health expenditures, garnering nearly $7 billion annually...

..Although follow-up is fairly short, no renal-cell carcinoma recurrences have appeared. At this point in time, the oncologic efficacy of a laparoscopic approach appears to mirror that of the open surgical technique...

..Post-operative morbidity leads to dramatically increased resource utilization. Prospective studies are needed to identify pre-operative risk factors and intraoperative process measures to optimize the quality of care...

..Using a population-based cohort, a competing risk analysis was performed to estimate patient survival after surgery for kidney cancer, as a function of patient age and tumor size at diagnosis...

..Surgeon discomfort is also dependent on the type of hand-assist device. The long-term consequences of physical strain on the laparoscopic surgeon are unknown currently, but measures to minimize neuromuscular strain should be considered...

..To better understand care coordination in the context of prostate cancer we examined how the delivery of prostate cancer care is partitioned across primary care providers and specialists...

..In testis cancer, the use of tumor markers is an important component of care and may represent a measurable quality indicator. We analyzed the use of testis cancer tumor markers across the United States...

..This study used a recently validated instrument, the Convalescence and Recovery Evaluation (CARE), to measure return to baseline health after surgery and explore clinical factors associated with recovery...

..To explore this possibility, we measured the impact of the opening of an ASC in a health care market, as defined by the hospital service area (HSA), on rates of procedure use...

..We sought to assess whether robot assistance would decrease the technical challenges and mitigate the considerable morbidity associated with the procedure...

..Historically, stone disease has been more common among men than women. However, differential changes in dietary intake patterns, fluid intake, and obesity in men and women may cause shifts in stone disease incidence and prevalence...

..All stakeholders, including physicians, the Medicare program and hospitals, will be affected by these changes...

..The impact of the increasing role of the primary care physician on the use of benign prostatic hyperplasia related health services remains unknown...

..We evaluated factors that impact the ability to learn hand-assisted laparoscopic donor nephrectomy (HALDN) to identify impediments to diffusion of this procedure...

..To evaluate this concern we used the SEER registry to characterize national practice patterns for the surgical management of small renal masses...

..These factors should be taken into consideration when counseling patients with localized prostate cancer regarding the expected, postimplantation sexual HRQOL outcome...

..Initial results with the lockout valve reservoir in preventing autoinflation are encouraging though additional study is warranted to justify their routine use...

..Our findings provide a basis by which expectations can be set for laparoscopic skill acquisition in the context of a residency program and for the laparoscopically naïve surgeon...

..04). CONCLUSIONS: LPN with closure using fibrin glue products provides adequate hemostasis when the CS or renal sinus is not entered. When the CS or renal sinus is entered, a sutured bolster is recommended...

..In addition to incontinence symptoms, obstructive symptoms were associated with urinary impairment and dissatisfaction in the prostatectomy group, suggesting that these symptoms should also be assessed after radical prostatectomy...

..However, the mediators of the volume effect remain unclear. We assessed whether differences among hospitals could explain some or all of the volume effect on short-term outcomes after cystectomy for bladder cancer...

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..Future trials should prospectively validate the role of these factors in either promoting (e.g., history of urolithiasis) or preventing (e.g., preoperative stent) a postoperative complication in the setting of stentless ureteroscopy...

..URS treatment of renal calculi is a safe and effective first-line treatment for renal calculi in MO patients...

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..To quantify the degree to which overall urologic oncology volume either reduces or enhances the effect of single procedure volume on short-term outcomes after urologic oncology surgery...

..SBP also appears to be an important factor. These results bear on the selection of techniques during laparoscopic partial nephrectomy...

..In particular, findings from this study have potential relevance to several important policy initiatives, including anti-self-referral legislation and payment reform for surgical care. ..