The Effect of Hospital Volume on Cancer Control After Radical Prostatectomy

Ellison, Lars M.; Trock, BJ; Poe, N.R.; Partin, Alan W.

doi:10.1097/01.ju.0000158156.80315.fe

Cited by 54 publications

(54 citation statements)

References 18 publications

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“…Various studies from the USA have examined such volume-outcome relationships using a Medicare database [2] . The patient demographics of this study are similar to previous population-based studies [9,10] . Though there was a great difference in the total number of radical procedures and volume thresholds in the present study and others, equal division of patients into 4 groups (quartiles) may nullify the cut-off volume threshold bias.…”

Section: Discussionsupporting

confidence: 70%

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

Hanchanale¹,

Javlé²

2010

Urol Int

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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.

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Section: Discussionsupporting

confidence: 70%

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

Hanchanale¹,

Javlé²

2010

Urol Int

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“…Similarly, registries can provide information on the quality of clinical care. In this context, studies based on several of these data sources have demonstrated that better outcomes might be achieved in high-volume hospitals and/or with more experienced surgeons [21,76]. The evaluation of large cohorts with follow-up data on cancer control has an important role in assessment of the safety and efficacy of PCa treatments [77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94].…”

Section: 4mentioning

confidence: 99%

Prostate Cancer Registries: Current Status and Future Directions

Gandaglia¹,

Bray

Cooperberg

et al. 2016

European Urology

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Context: Disease-specific registries that enroll a considerable number of patients play a major role in prostate cancer (PCa) research. Objective: To evaluate available registries, describe their strengths and limitations, and discuss the potential future role of PCa registries in outcomes research. Evidence acquisition: We performed a literature review of the Medline, Embase, and Web of Science databases. The search strategy included the terms prostate cancer, outcomes, statistical approaches, population-based cohorts, registries of outcomes, and epidemiological studies, alone or in combination. We limited our search to studies published between January 2005 and January 2015. Evidence synthesis: Several population-based and prospective disease-specific registries are currently available for prostate cancer. Studies performed using these data sources provide important information on incidence and mortality, disease characteristics at presentation, risk factors, trends in utilization of health care services, disparities in access to treatment, quality of care, long-term oncologic and health-related quality of life outcomes, and costs associated with management of the disease. Although data from these registries have some limitations, statistical methods are available that can address certain biases and increase the internal and external validity of such analyses. In the future, improvements in data quality, collection of tissue samples, and the availability of data feedback to health care providers will increase the relevance of studies built on population-based and disease-specific registries. Conclusions: The strengths and limitations of PCa registries should be carefully considered when planning studies using these databases. Although randomized controlled trials still provide the highest level of evidence, large registries play an important and growing role in advancing PCa research and care. Patient summary: Several population-based and prospective disease-specific registries for prostate cancer are currently available. Analyses of data from these registries yield information that is clinically relevant for the management of patients with prostate cancer.

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“…[3][4][5][6] Furthermore, ongoing controversy over many aspects of the management of prostate cancer 7,8 has led to regional and institutional variations in treatment 7,[9][10][11][12][13][14] with some evidence that these variations can lead to differences in outcome. 4,15,16 The timely evaluation of quality of care in the surgical treatment of prostate cancer has become a priority, although there is little known about which aspects of quality should be examined. 17 Quality of care research evaluates the ''degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.''…”

mentioning

confidence: 99%

Validation of quality indicators for radical prostatectomy

Chan

Groome

2008

Intl Journal of Cancer

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The feasibility and validity of proposed radical prostatectomy quality indicators has not been well studied. We assessed indicator availability from treating charts. We tested the convergent construct validity of a modified subset that were available from this information source by correlating them to hospital prostatectomy volume, a variable repeatedly associated with the quality of surgical care. The study population consisted of a stratified random sample of prostate cancer patients who were: (i) diagnosed between 1990 and 1998 in Ontario and (ii) treated by radical prostatectomy with curative intent within 6 months of diagnosis (n 5 645). Of the 9 candidate quality indicators assessed, 4 were missing for 25-56% of study subjects and were not analyzed further. We discuss the implications of this missing information on feasibility of their use. For blood transfusions of 3 units or greater, length of hospital stay and use of non-nerve-sparing surgical technique, worse outcomes were generally apparent with decreasing hospital volume. Acute complication rates and positive surgical margin rates did not increase with decreasing hospital volume. We were able to demonstrate convergent construct validity for 3 quality indicators. Upon further validation, this readily available information may be applied to aid providers and quality councils to more effectively identify problems and guide change in the management of early prostate cancer.

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The Effect of Hospital Volume on Cancer Control After Radical Prostatectomy

Cited by 54 publications

References 18 publications

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

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

Prostate Cancer Registries: Current Status and Future Directions

Validation of quality indicators for radical prostatectomy

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