Intra-community infanticide and forced copulation in spider monkeys: a multi-site comparison between Cocha Cashu, Peru and Punta Laguna, Mexico.

We describe two cases of infanticide, two suspected infanticides, and a forced copulation by familiar resident males in two populations of wild spider monkeys (Ateles belzebuth chamek and A. geoffroyi yucatanensis). These are the first known infanticides and forced copulation in spider monkeys.

Volume-based referral for cancer surgery: informing the debate.

Purpose: 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.

Patients And Methods: Data from the Nationwide Inpatient Sample were used to measure the likelihood of operative mortality and a prolonged length of stay (LOS) after six cancer surgeries (prostatectomy, cystectomy, esophagectomy, pancreatectomy, pneumonectomy, and liver resection) between 1993 and 2003. Using sampling weights, the adjusted likelihood of the outcomes was used to calculate the number of lives saved (or prolonged LOS avoided) in the United States.

Discharge practice patterns following cystectomy for bladder cancer: evidence for the shifting of the burden of care.

Purpose: Between 1985 and 2000 the incidence of bladder cancer in this country increased by 33%. Radical cystectomy is the primary treatment modality in patients with invasive disease. We characterized trends in cystectomy use and discharge practice patterns following cystectomy during a recent 13-year period.

The effects of adjusting for case mix on mortality and length of stay following radical cystectomy.

Purpose: Prior studies evaluating quality of care following radical cystectomy have been constrained by the use of retrospective reviews of single institutional series and limited ability to examine risk factors in a comprehensive manner. Characterization of these factors could enhance preoperative patient counseling and facilitate perioperative management, thereby improving the quality of patient care.

Materials And Methods: The National Surgical Quality Improvement Project is a prospective quality management initiative at 123 Veterans Affairs Medical Centers nationwide.

The economics of benign prostatic hyperplasia and lower urinary tract symptoms in the United States.

Throughout the past several decades, interest in health care economics has increased as health care spending has soared--currently in excess of 1.5 trillion dollars and comprising approximately 16% of the nation's Gross Domestic Product. Benign prostatic hyperplasia (BPH) and its associated clinical manifestation of lower urinary tract symptoms is one of the most common medical conditions of aging men.

Laparoscopy for renal cell carcinoma: diffusion versus regionalization?

Purpose: Recognizing the emergence of laparoscopy as a standard of care for surgical treatment in many patients with organ confined renal cell carcinoma, we explored the diffusion of this technology by examining temporal trends in the nationwide use of laparoscopic total and partial nephrectomy in patients with renal cell carcinoma.

Materials And Methods: Data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample were abstracted for 1991 through 2003. International Classification of Diseases-Ninth Revision, Clinical Modification 9 codes were used to identify patients undergoing open and laparoscopic total and partial nephrectomy for renal cell carcinoma.

Regionalization of percutaneous nephrolithotomy: evidence for the increasing burden of care on tertiary centers.

Purpose: The regionalization of procedures to specialized medical centers has been suggested as a means to improve the quality of care for select high risk procedures. Prior work has demonstrated the spontaneous regionalization of high risk procedures to tertiary centers. Similar concentration of complex, low risk procedures (e.

Temporal trends in the use of percutaneous nephrolithotomy.

Purpose: Treatment for nephrolithiasis has evolved because of the dissemination of less invasive techniques, such as ureteroscopy and shock wave lithotripsy. We examined temporal trends in PCNL use and characterized the determinants of a prolonged LOS and in-hospital mortality to provide insight into the evolution of practice patterns for nephrolithiasis treatment.

Materials And Methods: We abstracted data on 12,948 patients undergoing percutaneous procedures for urinary calculi between 1988 and 2002 from the Nationwide Inpatient Sample using International Classification of Disease, 9th revision, Clinical Modification procedure and diagnostic codes.

Ureteroscopic laser papillotomy to treat papillary calcifications associated with chronic flank pain.

Objectives: To evaluate retrospectively the efficacy and durability of a novel approach using ureteroscopic laser papillotomy for the treatment of painful papillary calcifications. Chronic pain due to renal papillary calcifications has not been addressed by current techniques.

Methods: Ureteroscopic holmium laser lithotripsy and papillotomy were performed on patients with chronic pain and radiographically visible papillary calcifications without free collecting system calculi.

Risk factors for adverse outcomes after transurethral resection of bladder tumors.

Background: Risk factors for adverse outcomes after transurethral resection of bladder tumors (TURBT) have not been identified to date. Such information would facilitate preoperative risk stratification and case-mix-adjusted outcome comparison, and lead to the development of processes of care directed at improving outcomes and ultimately the quality of care for bladder carcinoma patients.

Methods: The National Surgical Quality Improvement Program (NSQIP) is a prospective quality management initiative of 123 Veterans Affairs Medical Centers nationwide.

National utilization trends of partial nephrectomy for renal cell carcinoma: a case of underutilization?

Objectives: Partial nephrectomy is perceived to be more technically demanding than radical nephrectomy; concurrently, the increasing incidence of small renal tumors has suggested a greater role for nephron-sparing techniques. From a quality-of-care perspective, the underuse of partial nephrectomy may represent suboptimal delivery of healthcare.

Methods: A total of 66,621 subjects undergoing radical and partial nephrectomy for kidney cancer between 1988 and 2002 were identified from the Nationwide Inpatient Sample, a nationally representative data set of hospital discharges.

Racial disparities in resource utilization for cystectomy.

Objectives: To examine the association of race with mortality and resource use among patients requiring cystectomy for bladder cancer, given the known racial differences with regard to bladder cancer incidence and survival.

Methods: Using the Nationwide Inpatient Sample (a nationally representative data set), 22,088 patients who underwent cystectomy for bladder cancer from 1988 to 2000 were identified using the International Classification of Disease, Ninth Revision, codes. The outcomes included in-hospital mortality, length of stay (LOS), and discharge status.

Use of nephrectomy at select medical centers--a case of follow the crowd?

Purpose: Regionalization of high risk surgical procedures to larger, teaching hospitals has been suggested as a means to improve the quality of care. We determined the extent to which the regionalization of nephrectomy has occurred and describe the potential causes and implications of any observed regionalization.

Materials And Methods: The Nationwide Inpatient Sample comprises a 20% sampling of hospital discharges in the United States yearly.

Complications following surgical intervention for stress urinary incontinence: a national perspective.

Aims: Stress urinary incontinence (SUI) impacts many women. Treatment is primarily surgical. Post-operative morbidity considerably affects individuals and the health care system.

The regionalization of radical cystectomy to specific medical centers.

Purpose: Regionalization of high risk surgical procedures to larger teaching hospitals has been suggested as a means to improve the quality of care. We established a novel framework for characterizing regionalization, implemented it to determine the extent to which regionalization of radical cystectomy has occurred and delineated whether specific patient characteristics are associated with this phenomenon.

Materials And Methods: We used the Nationwide Inpatient Sample to identify 22,088 patients who underwent radical cystectomy for bladder cancer from 1988 to 2000.

Identifying risk factors for potentially avoidable complications following radical cystectomy.

Purpose: Morbidity after radical cystectomy is common and associated with increased health care resource use. Accurate characterization of complications after cystectomy, associated patient specific risk factors, and perioperative processes of care are essential to directing changes in perioperative management that will reduce morbidity and improve the quality of patient care.

Materials And Methods: The National Surgical Quality Improvement Program (NSQIP) is a prospective quality management initiative of 123 Veterans Affairs Medical Centers nationwide.

Quality of care: partial cystectomy for bladder cancer--a case of inappropriate use?

Purpose: Partial cystectomy is perceived to be a less morbid, less technically demanding procedure than radical cystectomy, although only select patients (approximately 6% to 10%) are appropriate candidates (solitary tumor in space/time, absence of carcinoma in situ). From a quality of care perspective, overuse of partial cystectomy may signify inappropriate delivery of health care.

Materials And Methods: Subjects who underwent extirpative treatment for bladder cancer between 1988 and 2000 were identified within the Surveillance, Epidemiology and End Results (SEER, 3,381) registry and the Nationwide Inpatient Sample (NIS, 22,088).

Racial differences in serum prostate-specific antigen (PSA) doubling time, histopathological variables and long-term PSA recurrence between African-American and white American men undergoing radical prostatectomy for clinically localized prostate cancer.

Objective: To determine if there are significant differences in biochemical characteristics, biopsy variables, histopathological data, and rates of prostate-specific antigen (PSA) recurrence between African-American (AA) and white American (WA) men undergoing radical prostatectomy (RP), as AA men are twice as likely to die from prostate cancer than their white counterparts.

Patients And Methods: We established a cohort of 1058 patients (402 AA, 646 WA) who had RP and were followed for PSA recurrence. Age, race, serum PSA, biopsy Gleason score, clinical stage, pathological stage, and PSA recurrence data were available for the cohort.

Aggressive treatment for bladder cancer is associated with improved overall survival among patients 80 years old or older.

Objectives: To examine the impact of various treatment modalities on survival among patients with bladder cancer who were 80 years old or older compared with younger patients. A compendium of evidence suggests that bladder cancer surgery is safe among octogenarians; however, the benefit of such treatment in a population with limited life expectancy has not been well documented.

Methods: Subjects with the primary diagnosis of bladder cancer were identified from the National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry between 1988 and 1999.

Impact of surgical volume on mortality and length of stay after nephrectomy.

Objectives: To evaluate the volume-outcome relationship in patients undergoing nephrectomy for neoplastic disease by examining the impact of the number of cases performed on in-hospital mortality and length of stay. Surgical volume is associated with postoperative mortality for many complex procedures; however, this relationship has not been characterized for patients undergoing nephrectomy for neoplastic disease.

Methods: Using the Nationwide Inpatient Sample database, 20,765 patients who underwent nephrectomy for neoplasm from 1993 through 1997 were identified by International Classification of Disease, Ninth Revision codes.