Assessing the relative influence of hospital and surgeon volume on short‐term mortality after radical cystectomy

Waingankar, Nikhil; Mallin, Katherine; Smaldone, Marc C.; Egleston, Brian L.; Higgins, Andrew M.; Winchester, David P.; Uzzo, Robert G.; Kutikov, Alexander

doi:10.1111/bju.13804

Cited by 49 publications

(44 citation statements)

References 40 publications

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“…This difference is largely explained by the shorter time of observation, since LOS in the United States was also less than half that in Germany (10.7 vs. 25.2 days). When comparing current 30-or 90-day mortality rates from the literature, the difference between the 2 countries appears negligible [3,7,13]. Additionally, the mean age of RC patients in Germany is higher and constantly inclining in Germany [4,6], while older age proved to be the most important risk factor for in-hospital mortality in both countries followed by annual caseload.…”

Section: Discussionmentioning

confidence: 95%

“…For patients with muscle-invasive or superficial treatment-refractory cancer radical cystectomy (RC) remains the gold standard. The morbidity and mortality are among the highest in oncological surgery [3][4][5][6][7]. Influential factors are the high level of invasiveness combined with patient-derived factors such as the elevated mean patient's age and greater comorbidity [4,6,8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Higher surgical volume is associated with improved outcomes [7,[10][11][12][13], but the magnitude of this effect remains controversial. While several studies emphasize the importance of the surgeon's experience [7], the influence of treating institution and perioperative management might be additional key factors to reduce in-hospital morbidity and mortality [10,11,13]. The introduction of laparoscopic RC (LRC) and later robot-assisted RC (RARC) has achieved less blood loss, wound infections, and a shorter length of hospital stay (LOS) compared to open RC (ORC) in several single-center studies [5,14].…”

Section: Introductionmentioning

confidence: 99%

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In-Hospital Outcomes after Radical Cystectomy for Bladder Cancer: Comparing National Trends in the United States and Germany from 2006 to 2014

et al. 2019

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Background: Radical cystectomy (RC) still poses a significant risk for mortality and morbidity. Objectives: We compared in-hospital outcomes after RC in the United States and Germany using population-based data. Methods: We compared data from the US Nationwide Inpatient Sample to the German hospital billing database. Mortality and transfusion during hospital stay and length of stay (LOS) were evaluated. Results: In all, 17,711 (the United States) and 60,447 (Germany) cases were included. The share of robot-assisted RC increased to 20.5% in the United States vs. 2.3% in Germany (p < 0.001). In-hospital mortality was 1.9% (the United States) vs. 4.6% (Germany), transfusion rates were 34.2% (the United States) vs. 58.7% (Germany), and LOS was 10.7 (the United States) vs. 25.1 days (Germany; all p < 0.001). On multivariate analysis, higher patient age and lower annual hospital caseload were associated with increased mortality and longer LOS. Minimal-invasive surgery was associated with less blood transfusion and shorter LOS in the United States vs. hospital caseload and choice of urinary diversion in Germany. Conclusions: Healthcare systems might exert a relevant impact on outcomes of oncologic surgery. Increased in-hospital mortality rates in Germany seem to be partly explained by much longer LOS compared to those in the United States. Annual caseload seems to be influential on in-hospital outcomes raising the question of centralization of RC.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In-Hospital Outcomes after Radical Cystectomy for Bladder Cancer: Comparing National Trends in the United States and Germany from 2006 to 2014

et al. 2019

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“…Various studies in other regions have suggested that the outcome of RC is improved in high‐volume settings . Most of these studies found that hospital RC volume, but not surgeon RC volume independently predicted improved clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Various studies in other regions have suggested that the outcome of RC is improved in high-volume settings. 6,9,[23][24][25] Most of these studies found that hospital RC volume, but not surgeon RC volume independently predicted improved clinical outcomes. However, we found the opposite to be true: a surgeon's RC load was an independent predictor for 90-day postoperative mortality, overall survival, and BC-specific survival.…”

Section: Discussionmentioning

confidence: 99%

Short‐ and long‐term survival has improved after radical cystectomy for bladder cancer in Québec during the years 2000‐2015

Wissing

Santos

Zakaria

et al. 2019

Journal of Surgical Oncology

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Background and Objectives We evaluated the short‐ and long‐term outcome in bladder cancer (BC) patients treated with radical cystectomy (RC) in Québec (Canada). Methods Data were collected from provincial registries on all BC patients who underwent RC in Québec province in 2000‐2015. Outcomes were hospitalization rates and survival. Survival analyses were conducted using log‐rank tests and Cox proportional hazards models. Results In total, 4450 patients were included in our analysis. RC was increasingly conducted by higher‐volume surgeons in larger, higher‐volume, academic hospitals. Comparing patients treated in 2010‐2015 to 2000‐2009, recently treated patients had shorter postoperative hospital stays (absolute difference, 0.9 days, P < 0.001) but also a higher readmission rate (25.0% vs 21.1% in the 30 days following discharge, P = 0.003). Overall (5‐year rates 50.9% vs 42.7%, P < 0.001) and BC‐specific survival (61.3% vs 55.5%, P < 0.001) had significantly improved. In multivariable analyses, overall survival was significantly better in recently treated patients (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.60‐0.73), younger patients (HR, 1.16; 95% CI, 1.14‐1.19), patients residing closer to the hospital (HR, 1.03; 95% CI, 1.01‐1.06), and patients treated by high‐volume surgeons (HR, 0.88; 95% CI, 0.82‐0.94). Conclusions Survival in BC patients after RC has improved in recent years. Other predictors for survival are younger age, shorter distance between patients' residences and hospitals, and higher surgeon's RC loads.

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Improved survival for extremity soft tissue sarcoma treated in high‐volume facilities

Abarca

Gao

Monga

et al. 2018

Journal of Surgical Oncology

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Assessing the relative influence of hospital and surgeon volume on short‐term mortality after radical cystectomy

Cited by 49 publications

References 40 publications

In-Hospital Outcomes after Radical Cystectomy for Bladder Cancer: Comparing National Trends in the United States and Germany from 2006 to 2014

In-Hospital Outcomes after Radical Cystectomy for Bladder Cancer: Comparing National Trends in the United States and Germany from 2006 to 2014

Short‐ and long‐term survival has improved after radical cystectomy for bladder cancer in Québec during the years 2000‐2015

Improved survival for extremity soft tissue sarcoma treated in high‐volume facilities

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