Survival after treatment for carcinoma invading bladder muscle: a Dutch population‐based study on the impact of hospital volume

Goossens‐Laan, Catharina A.; Visser, Otto; Hulshof, Maarten C.C.M.; Wouters, Michel W. J. M.; Bosch, J.L.H. Ruud; Coebergh, Jan Willem; Kil, Paul

doi:10.1111/j.1464-410x.2011.10694.x

Cited by 40 publications

(24 citation statements)

References 19 publications

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“…22 With respect to hospital volume, an analysis of Netherlands Cancer Registry data did reveal a significant mortality detriment for an annual cystectomy volume of < 10 (HR, 1.17; 95% CI, 1.01-1.35). 23 However, these analyses did not account for clustering of data or adjuvant chemotherapy in a time-dependent manner, both of which may contribute to false-positive findings. 17,18,20 Finally, Birkmeyer et al assessed the association between hospital volume and late survival in 2514 patients who underwent cystectomy using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data but failed to demonstrate a significant association in adjusted analyses.…”

Section: Discussionmentioning

confidence: 99%

Higher surgeon and hospital volume improves long‐term survival after radical cystectomy

Kulkarni

Urbach

Austin

et al. 2013

Cancer

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BACKGROUND: Hospital and surgeon (provider) volume are associated with clinically significant outcomes for many types of surgery. Volume-outcome studies in patients undergoing radical cystectomy for bladder cancer have focused primarily on postoperative mortality. In the current study, the authors assessed the effect of cystectomy provider volume on long-term mortality. METHODS: Using administrative databases, 2535 patients who underwent cystectomy by 199 surgeons in 90 hospitals in Ontario, Canada, between 1992 and 2004 were identified. The impact of provider volume on overall survival (OS) was assessed using Cox proportional hazards models fully adjusted for patient and tumor characteristics. Separate models were fit to examine the effect of surgeon and hospital volume. To confirm that the impact of volume on OS was independent of the effect of volume on short-term mortality, analyses were repeated excluding those patients experiencing postoperative deaths. RESULTS: Of 2535 patients, 1796 (70.9%) died during the study period. Both higher hospital volume (hazards ratio [per unit increase in average annual number of procedures], 0.995; 95% confidence interval, 0.990-1.000 [P 5.044]) and higher surgeon volume (hazards ratio, 0.984; 95% confidence interval, 0.975-0.994 [P 5.002]) were found to be significantly associated with improved OS. Excluding post-operative deaths did not alter the results. Further analyses revealed that the benefit of high volume was attained by receiving care from either high-volume hospitals or highvolume surgeons. CONCLUSIONS: High-volume providers were associated with improved long-term mortality rates compared with low-volume providers. This finding was independent of the effect of volume on perioperative mortality, suggesting that provider volume effects continue to manifest long after surgery. Cancer 2013;119:3546-54. V C 2013 American Cancer Society.KEYWORDS: cystectomy; bladder cancer; quality of health care; outcomes; bladder neoplasm. INTRODUCTIONPatients who undergo radical cystectomy for bladder cancer are at significant risk of postoperative death and have a poor life expectancy. Postoperative mortality rates and 5-year overall survival rates typically range between 1% and 4% and 40% and 60%, 1-6 respectively. One way to improve on these outcomes is to optimize the quality of care for patients undergoing radical cystectomy. Several studies have demonstrated that hospitals and surgeons with higher cystectomy volumes generally have better postoperative outcomes compared with lower-volume providers.

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Section: Discussionmentioning

confidence: 99%

Higher surgeon and hospital volume improves long‐term survival after radical cystectomy

Kulkarni

Urbach

Austin

et al. 2013

Cancer

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“…Nevertheless, the relationship between provider volume and outcome in the literature seems to indicate that better outcomes are observed by higher volume providers. [10][11][12][13][21][22][23] Recently, health policy recommendations (publicly funded [24][25][26] or private-based 27 ) have been proposed to adopt the idea of centralization or regionalization of urologic-oncology care, based on several studies. 26,[28][29][30] On the other hand, several investigators reported methodological defects in studies supporting higher volume effect after highlighting the limitations of the measures used to assess the volume-outcome relationship.…”

Section: Zakaria Et Almentioning

confidence: 99%

Postoperative mortality and complications after radical cystectomy for bladder cancer in Quebec: A population-based analysis during the years 2000-2009

Zakaria

Santos

Dragomir

et al. 2014

CUAJ

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Introduction: Radical cystectomy (RC) is a very complex urologic procedure. Despite improvements in practice, technique and process of care, it is still associated with significant complications, including death, with reported postoperative mortality rates ranging from 0.8% to 8%. We examine the quality of surgical care indicators and document the mortality rates at 30, 60 and 90 days after RC across Quebec. Methods: Within the Régie de l'assurance maladie du Québec (RAMQ) administrative database (this database provides prospectively collected universal data on all medical services) and the Institut de la statistique du Québec (ISQ) database (this provides vital status data), we used procedure codes to identify patients who underwent RC for bladder cancer in Quebec over 10 years (between 2000 and 2009), as well as RC outcomes and dates of death. Data obtained were retrospectively analyzed in relation to multiple parameters, including patient characteristics and healthcare providers' volumes. The outcomes analyzed included postoperative complications and mortality rates at 30, 60 and 90 days. Results: A total of 2778 RC were performed in 48 hospitals by 122 urologists across Quebec. Among them, 851 (30.6%) patients had at least one postoperative complication and 350 (12.6%) patients had more than one complication. The overall mortality rates at 30, 60 and 90 days were 2.8%, 5.3% and 7.5%, respectively, with significantly elevated 90-day mortality rates in some centres. In the multivariate analysis, increased age was associated with increased risk of post-RC complications and mortality. For example, patients over 75 had more chance of having at least one postoperative complication (odds ratio [OR] 1.66, 95% confidence interval [CI]: 1.31-2.11) and mortality at 90 days (OR 3.28, 95% CI: 2.05-5.26). Provider volume effect on outcomes was statistically significant, with large hospitals having decreased risk of 30-day mortality (OR 0.29, 95% CI: 0.12-0.70), 60-day mortality (OR 0.41, 95% CI: 0.26-0.82) and 90-day mortality (OR 0.52, 95% CI: 0.29-0.93) when compared to smaller hospitals. Surgeon volume showed weak, but not statistically significant, evidence of reduced odds of mortality for the high-volume surgeon. Limitations to our study include reliance on administrative data, which lack some relevant clinical information (such as patient functional status and tumour pathological characteristics) to perform risk adjustment analysis. Conclusion: Our study demonstrates that postoperative outcomes after RC in Quebec varies based on several parameters. In addition, 30-day postoperative mortality after RC in Quebec appears acceptable. However, 90-day postoperative mortality rates remain significantly elevated in some centres, particularly in the elderly. This requires further research. IntroductionUrinary bladder cancer (BC) is common in North America and is the second most frequent genitourinary tract tumour in terms of incidence and mortality. 1,2Radical cystectomy (RC) and urinary diversion are the gold standa...

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“…Radical cystectomy with pelvic lymphadenectomy represents a challenge for urologists and is the gold standard treatment for non-metastatic, muscle-invasive (or high-risk non-muscle-invasive) bladder cancer (8). The complications following radical cystectomy are due, in most cases, to the intestinal resection; however, Shabsigh et al (9) documented a high incidence of thromboembolic complications (8%) and bleeding complications, with a transfusion rate of ~9%.…”

Section: Introductionmentioning

confidence: 99%

Association between postoperative thromboembolism prophylaxis and complications following urological surgery

Cerruto

D’Elia

Piccoli

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Thromboembolism represents the most significant complication and cause of non-surgical mortality in major urological surgery. The aim of the present study was to assess the association between the type of pharmacological thromboembolism prophylaxis and the postoperative complication rate in a cohort of patients undergoing major urological surgery. All consecutive patients treated with major urological surgery between December 2011 and March 2013 were evaluated. For each patient, clinical and demographic data, as well as information on the post-surgical complications and the type of pharmacological thromboembolism prophylaxis, were collected. In total, 453 patients (mean age, 63.36±12.05 years) were recruited (43.5% for prostate surgery, 33.1% for renal surgery, 12.1% for bladder surgery and 11.3% for other surgery). Postoperative blood transfusions were required in 50 cases (11.0%). A total of 32 patients (7.1%) underwent re-intervention due to the occurrence of grade ≥3 complications, with a readmission rate of 2.0%. According to the Clavien-Dindo Classification, the complications were grade 1 in 36.0% of the cases, grade 2 in 19.4%, grade 3 in 6.0%, grade 4 in 2.0% and grade 5 (mortality) in 0.7%. Only 1 case of deep venous thrombosis not associated with pulmonary thromboembolism was observed. Univariate analyses showed a significant negative association (higher risk of complications) between the use of >4,000 IU enoxaparin as the thromboembolism prophylaxis and postoperative blood transfusion rate (P= 0.045), re-intervention rate (P=0.001) and the occurrence of grade ≥3 complications (P<0.001). Multivariate analysis confirmed the significant association between the use of >4,000 IU enoxaparin and both re-intervention rate (P=0.013) and occurrence of grade ≥3 complications (P=0.002). High doses of enoxaparin (>4,000 IU) may lead to an increased risk of re-intervention and severe postoperative complications following major urological surgery. Randomised, controlled trials comparing the effect of different types of pharmacological thromboembolism prophylaxis on postoperative complications following major urological surgery are required.

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Survival after treatment for carcinoma invading bladder muscle: a Dutch population‐based study on the impact of hospital volume

Cited by 40 publications

References 19 publications

Higher surgeon and hospital volume improves long‐term survival after radical cystectomy

Higher surgeon and hospital volume improves long‐term survival after radical cystectomy

Postoperative mortality and complications after radical cystectomy for bladder cancer in Quebec: A population-based analysis during the years 2000-2009

Association between postoperative thromboembolism prophylaxis and complications following urological surgery

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