Effect of Hospital and Surgeon Case Volume on Perioperative Quality of Care and Short-term Outcomes After Radical Cystectomy for Muscle-invasive Bladder Cancer: Results From a European Tertiary Care Center Cohort

Vetterlein, Malte W.; Meyer, Christian; Leyh-Bannurah, Sami-Ramzi; Mayr, Roman; Gierth, Michael; Fritsche, Hans‐Martin; Burger, Maximilian; Keck, Bastian; Wullich, Bernd; Martini, Thomas; Bolenz, Christian; Pycha, Armin; Hanske, Julian; Roghmann, Florian; Noldus, Joachim; Bastian, Patrick J.; Gilfrich, Christian; May, Matthias; Rink, Michael; Chun, Felix K.‐H.; Dahlem, Roland; Aziz, Atiqullah; Bartsch, Georg; Brookman‐May, Sabine; Büchner, Alexander; Durschnabel, M.; Ellinger, Jörg; Froehner, Michael; Georgieva, Galia; Gördük, Murat; Grimm, Marc‐Oliver; Hadaschik, Boris; Haferkamp, Axel; Hakenberg, Oliver W.; Hartmann, Florian; Herrmann, Edwin; Hertle, L.; Hohenfellner, Markus; Janetschek, Georg; Kraischits, Nicole; Krausse, Annerose; Lusuardi, Lukas; Michel, Maurice Stephan; Moritz, Rudolf; Müller, Stefan; Novotný, Vladimír; Nuhn, Philipp; Pahernik, Sascha; Palisaar, Rein-Jüri; Ponholzer, Anton; Protzel, Chris; Roigas, Jan; Schmid, Marianne; Schramek, Paul; Seitz, C.; Sikic, Danijel; Stief, Christian G.; Syring, Isabella; Vallo, Stefan; Wagenlehner, Florian M. E.; Weidner, W.; Wirth, Manfred P.

doi:10.1016/j.clgc.2017.04.021

Cited by 22 publications

(18 citation statements)

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“…Unlike others, we found no significant relationship between hospital volume and poorer outcomes following RC. It is possible that while our cohort was population‐based, the number of RCs performed over the 15 years was fewer than that observed in overseas jurisdictions with larger populations .…”

Section: Discussioncontrasting

confidence: 99%

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Outcomes following radical cystectomy: a population‐based study from Queensland, Australia

Coughlin

Youl

Philpot

et al. 2019

ANZ Journal of Surgery

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Background: Radical cystectomy (RC) is a complex uro-oncology surgical procedure with high surgical morbidity. We report on outcomes following RC for bladder cancer using a population-based cohort of patients. Methods: Patients receiving an RC from 2002 to 2016 were included and linked to their cancer-related surgical procedures. Hospitals were categorized as high (>7 RCs/year) and low (≤7 RCs/year). Outcomes included 30-and 90-day mortalities and 2-year overall survival (OS). Multivariable logistic regression models were used to examine factors associated with the outcomes of interest. OS was estimated using the Kaplan-Meier survival function. Results: During the 15-year study period, 1230 patients underwent an RC for invasive bladder cancer. In-hospital mortality was 1.1%, and 30-and 90-day mortality was 1.4% and 2.9%, respectively. Both 30-and 90-day mortalities were significantly higher for older versus younger patients (P = 0.01 and P < 0.001, respectively), and lymph node involvement was significantly associated with 90-day mortality (P = 0.002). Patients treated more recently were about 80% less likely to die within 90 days. The 2-year OS was 71.5%, with significant improvements observed over time (P < 0.001). While we found no evidence of a hospital-volume relationship for post-operative mortality or survival, patients treated in lowvolume compared to high-volume hospitals were more likely to have surgical margin involvement (10.9% versus 7.1%, respectively, P = 0.03). Conclusion: We observed low post-operative mortality rates overall, with rates decreasing significantly over time. Some subgroups of patients experience poorer post-operative outcomes. Reporting on post-operative outcomes, and survival over time helps monitor clinical progress and identify areas for improvement.

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Section: Discussioncontrasting

confidence: 99%

“…It has been well established that complex surgical procedures when conducted in high‐volume hospitals results in improved patient outcomes . Evidence is also growing of an inverse relationship between outcomes and hospital and surgeon volume following RC …”

Section: Introductionmentioning

confidence: 99%

Outcomes following radical cystectomy: a population‐based study from Queensland, Australia

Coughlin

Youl

Philpot

et al. 2019

ANZ Journal of Surgery

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“…The hospital and surgeon annual volume of RCs may appear relatively low as compared with other studies; for example, Vetterlein et al reported that approximately half of their cohort was treated by surgeons with an annual case volume of >15 surgeries per year. However, it needs to be noted that in our cohort, RCs were only counted when the indication for the surgery was BC.…”

Section: Discussionmentioning

confidence: 76%

“…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%

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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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Effect of Hospital and Surgeon Case Volume on Perioperative Quality of Care and Short-term Outcomes After Radical Cystectomy for Muscle-invasive Bladder Cancer: Results From a European Tertiary Care Center Cohort

Cited by 22 publications

References 17 publications

Outcomes following radical cystectomy: a population‐based study from Queensland, Australia

Outcomes following radical cystectomy: a population‐based study from Queensland, Australia

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

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