Impact of Hospital Provider Volume on Outcome for Radical Urological Cancer Surgery in England

Abstract

Introduction: Complex surgical procedures are associated with higher mortality and morbidity. There is a paucity of data supporting a volume-outcome relationship in the United Kingdom. We analysed Hospital Episode Statistics (HES) to contemplate the association of hospital provider volume and short-term outcomes (mortality rate and hospital stay) for 3 radical urological procedures in England. Materials and Methods: The HES database was extracted for radical prostatectomy (RP), radical cystectomy (RC) and radical nephrectomy (RN) using ICD-10 and OPCS-4 codes for 7 years. Hospitals were divided into quartiles depending on the annual hospital volume. The impact of hospital provider volume was analysed for outcomes. Results: Overall 43,946 patients were included in the study. RP patients had the lowest mortality rate (0.2%) and shorter in-patient stay (7 days). Mortality from RC and RN were 475 (5.3%) and 537 (2.6%), respectively. There was no significant difference for mortality following RP in four volume groups (p = 0.76). The mortality rate for RC decreased from 6.9% in the very low-volume group to 4.1% in the high-volume group (p < 0.001) without change in the in-hospital stay. The proportion of patients treated at high-volume centres for RP, RC and RN has increased from 0 to 42, 22 to 35 and 10 to 38%, respectively, over a 7-year study period. Conclusion: In England, hospital provider volume has a significant impact on outcome measures for radical pelvic urological procedures with a lower mortality (RC) and shorter in-patient stay (RP). Thus HES data from England support the hospital volume-outcome relationship and emphasise the centralisation of care for radical urological procedures.

Centralisation of radical cystectomies for bladder cancer in England, a decade on from the ‘Improving Outcomes Guidance’: the case for super centralisation

“…The difference seen in survival outcomes in our present study between IOG‐compliant and IOG‐non‐compliant procedures is more marked than those described in previous studies in the UK . This disparity may well be as a result of the acceleration in centralisation noted after 2007.…”

Long-term follow-up after radical cystectomy with emphasis on complications and reoperations: A Swedish population-based survey

“…Using this stratification, hospital volume had no effect on reoperations or 90-day mortality in the present study. Postoperative mortality has previously been described as being dependent on hospital caseload [13,15,[17][18][19][20], but data on reoperation rates and hospital volume are lacking, except for in the present study. However, caseload is probably more important with regard to treating muscle-invasive bladder cancer, as cystectomy is more frequently performed in patients diagnosed in high-volume than in low-volume units (37% and 26%, respectively) [21].…”

“…The majority of units performing radical cystectomy performed fewer than five operations per year (23 hospitals), whereas 11 hospitals performed between five and nine cystectomies annually. In the units classified as high-volume units, the mean number of cystectomies annually during the study period was 16 (median 15, range [13][14][15][16][17][18][19][20]. The mean duration of surgery was 343 min and mean intraoperative blood loss was 2000 ml.…”

Centralisation of services for children with cleft lip or palate in England: a study of hospital episode statistics

“…A relationship between increasing provider volume and a reduction in hospital stay has been reported by a number of studies [16-18]. A reduction in length of stay has also been observed in other areas of surgery over a similar time period [17].…”