A Systematic Review and Critique of the Literature Relating Hospital or Surgeon Volume to Health Outcomes for 3 Urological Cancer Procedures

Abstract

Outcomes after radical prostatectomy and cystectomy are on average likely to be better if these procedures are performed by and at high volume providers. For radical nephrectomy the evidence is unclear. The impact of volume based policies (increasing volume to improve outcomes) depends on the extent to which "practice makes perfect" explains the observed results. Further studies should explicitly address selective referral and confounding as alternative explanations. Longitudinal studies should be performed to evaluate the impact of volume based policies.

Monitoring Quality of Care in Men Diagnosed with Prostate Cancer: Developing Consensus Quality Indicators Using Modified-Delphi Methodology

“…This is at odds with a systematic review which suggested that provider volume (both hospital and surgeon) is an acceptable surrogate measure for quality-of-care in uro-oncological procedures [10]. In explaining why the panel did not enforce volume indictors, it may reflect the heterogeneity of the group or the contradicting evidence of a volume: quality relationship across all fields of medicine.…”

“…Best practice guidelines have been developed to guide prostate cancer management and clinical indicators have been devised to measure how well prostate cancer care aligns with these guidelines [8][9][10][11]. Researchers in the US have led quality indicator development using a multi-step process involving literature review, focus groups with patients and family members, interviews with clinical experts and panel discussion from the fields of urology, radiation oncology, medical oncology and health services research [12].…”

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

“…299 With respect to provider cystectomy volumes, a systematic review of eight studies relating hospital cystectomy volumes to outcomes showed that each of the studies demonstrated improvement in at least one outcome with higher compared to lower volume. 304 Analyses of Canadian data have also consistently demonstrated that higher volume of cases correlates with better outcomes, including lower mortality risk. 290,291,305 Improving bladder cancer care…”

Hospital Volume and Operative Mortality in the Modern Era

“…Over the last ten years, a large body of literature supporting the presence of a hospital volume-outcome relationship, including numerous systematic reviews, [18][19][20][21][22][23][24][25] has been developed. An early definitive systematic review on the subject was performed by Halm and colleagues and reported a significant association across a wide range of procedures and conditions.…”