Defining a "High Volume" Radical Cystectomy Hospital: Where Do We Draw the Line?
Bladder neoplasms
Hospital volume
National Inpatient Sample
Radical cystectomy
Robotic radical cystectomy
Journal
European urology focus
ISSN: 2405-4569
Titre abrégé: Eur Urol Focus
Pays: Netherlands
ID NLM: 101665661
Informations de publication
Date de publication:
15 09 2020
15 09 2020
Historique:
received:
18
12
2018
revised:
20
01
2019
accepted:
01
02
2019
pubmed:
18
2
2019
medline:
21
5
2021
entrez:
18
2
2019
Statut:
ppublish
Résumé
Centralization of radical cystectomy (RC) to "high volume" centers can lead to decreased morbidity but also limits access to care. In the context of centralization, there is a need to systematically define the hospital volume cutoffs for this procedure. To systematically examine the effect of hospital volume on inpatient complications of RC for bladder cancer and to define a threshold to minimize RC morbidity. This was a retrospective analysis of data for 6790 adults undergoing RC for nonmetastatic bladder cancer during 2008-2011 from the National Inpatient Sample (weighted population estimate of 33 249 RCs in the USA during this period). RC. Overall and major complications were defined according to International Classification of Diseases (9th revision) diagnosis and procedure codes. To define the relationship between hospital volume and morbidity, logistic regression analyses within a generalized estimating equation framework with restricted cubic splines were used. The inpatient complication rate was 4769/6790 (70.2%), of which 1572/6790 (23.2%) were major complications. Restricted cubic spline analysis revealed a significant inverse nonlinear association between hospital volume and complications. The odds of complications decreased with increasing volume, with a plateau at 50-55 cases/yr for any complications (p=0.024) and 45-50 cases/yr for major complications (p=0.007). The relationship between hospital volume and RC morbidity is nonlinear, with a plateau for the complication rate at 50-55 cases/yr. Restricting RC to centers with such high thresholds will restrict access to care. There is a need to identify and publish best practices from high-volume centers in quality improvement initiatives to improve morbidity at low-volume centers. There is a nonlinear relationship between the annual number of radical cystectomy procedures performed at a hospital and the inpatient complication rate. Complications decrease with increasing hospital volume and reach a plateau at 50-55 cases per year, beyond which the incremental benefit of increasing volume is minimal.
Sections du résumé
BACKGROUND
Centralization of radical cystectomy (RC) to "high volume" centers can lead to decreased morbidity but also limits access to care. In the context of centralization, there is a need to systematically define the hospital volume cutoffs for this procedure.
OBJECTIVE
To systematically examine the effect of hospital volume on inpatient complications of RC for bladder cancer and to define a threshold to minimize RC morbidity.
DESIGN, SETTING, AND PARTICIPANTS
This was a retrospective analysis of data for 6790 adults undergoing RC for nonmetastatic bladder cancer during 2008-2011 from the National Inpatient Sample (weighted population estimate of 33 249 RCs in the USA during this period).
INTERVENTION
RC.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Overall and major complications were defined according to International Classification of Diseases (9th revision) diagnosis and procedure codes. To define the relationship between hospital volume and morbidity, logistic regression analyses within a generalized estimating equation framework with restricted cubic splines were used.
RESULTS AND LIMITATIONS
The inpatient complication rate was 4769/6790 (70.2%), of which 1572/6790 (23.2%) were major complications. Restricted cubic spline analysis revealed a significant inverse nonlinear association between hospital volume and complications. The odds of complications decreased with increasing volume, with a plateau at 50-55 cases/yr for any complications (p=0.024) and 45-50 cases/yr for major complications (p=0.007).
CONCLUSIONS
The relationship between hospital volume and RC morbidity is nonlinear, with a plateau for the complication rate at 50-55 cases/yr. Restricting RC to centers with such high thresholds will restrict access to care. There is a need to identify and publish best practices from high-volume centers in quality improvement initiatives to improve morbidity at low-volume centers.
PATIENT SUMMARY
There is a nonlinear relationship between the annual number of radical cystectomy procedures performed at a hospital and the inpatient complication rate. Complications decrease with increasing hospital volume and reach a plateau at 50-55 cases per year, beyond which the incremental benefit of increasing volume is minimal.
Identifiants
pubmed: 30772360
pii: S2405-4569(19)30018-5
doi: 10.1016/j.euf.2019.02.001
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
975-981Informations de copyright
Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.