The morbidity of radical cystectomy remains high. A multidisciplinary approach utilizing hospitalist comanagement may improve outcomes. It is unclear what factors should be considered to determine which patients might benefit from this approach. We sought to determine if there are differences between the perceived need for co-management between urologists and hospitalists. Preoperative variables were analyzed to determine which factors might be associated with need for comanagement.
A case-based survey was emailed to urologists and hospitalists at 3 academic institutions to investigate perceptions regarding need for inpatient medical comanagement of fictitious patients following cystectomy. Decisions were rated based on patient comorbidities, age, race, sex, cancer stage, neoadjuvant therapy, alcohol intake, performance status, and English literacy. A Wilcoxon rank sum test assessed each question for differences. A Mantel-Haenszel chi-square test was used to assess whether the proportion of respondents who advocated for comanagement increased as Charlson comorbidity score increased.
The most significant determinant of need for postoperative comanagement was patients' comorbidities. Urologists and hospitalists did not differ significantly in beliefs regarding need for comanagement.
The most important determining factor for comanagement was presence of comorbidities. Further studies are needed to evaluate the impact of this multidisciplinary approach.
Current urology. 2017 Nov 30 [Epub]
Jessica H Hannick, William Adams, Jasmin Sandhu, Stephanie Kliethermes, Daniel J Mazur, Joshua J Meeks, Sabine Sobek, Christopher L Coogan, Aliyah Sadaf, Marcus L Quek, Elizabeth Schulwolf
Department of Urology, Loyola University Medical Center, Maywood, Chicago, Ill, USA., Department of Medicine, Loyola University Medical Center, Maywood, Chicago, Ill, USA., Department of Health Sciences Division, Loyola University, Chicago, Maywood, Chicago, Ill, USA., Department of Urology, Northwestern Memorial Hospital, Chicago., Department of Internal Medicine, Northwestern Memorial Hospital, Chicago., Department of Urology, Rush University Medical Center, Chicago, Ill, USA., Department of Medicine, Rush University Medical Center, Chicago, Ill, USA.