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Waingankar N , Mallin K , Smaldone M , Egleston BL , Higgins A , Winchester DP , Uzzo RG , Kutikov A
Assessing the relative influence of hospital and surgeon volume on short-term mortality after radical cystectomy
BJU Int. 2017 Aug;120(2) :239-245
PMID: 28192632    PMCID: PMC7536895    URL: https://www.ncbi.nlm.nih.gov/pubmed/28192632
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Abstract
OBJECTIVES: To assess the relationship between surgeon (SV) and hospital volume (HV) on mortality after radical cystectomy (RC). PATIENTS AND METHODS: We queried the National Cancer Database (NCDB) for adult patients undergoing RC between 2010 and 2013. We calculated average volume for each surgeon and hospital. Using propensity-scored weights for combined volume groups with a proportional hazards regression model, we compared the associations between HV and SV with 90-day survival after RC. RESULTS: A total of 19 346 RCs were performed at 927 hospitals by 2 927 surgeons in the period 2010-2013. The median (interquartile range) HV and SV were 12.3 (5.0-35.5) and 4.3 (1.3-12.3) cases, respectively. For HV, 90-day unadjusted mortality was 8.5% in centres with <5 cases/year (95% confidence interval [CI] 7.7-9.3) and 5.6% in those with >30 cases/year (95% CI 5.0-6.2). For SV, 90-day mortality was 8.1% for surgeons with <5 cases/year (95% CI 7.6-8.6) and 4.0% for those with >30 cases/year (95% CI 2.8-5.2; all P < 0.05). The 30-day mortality rate was lowest for the combined HV-SV groups with HV >30, ranging from 1.6% to 2.1%. CONCLUSIONS: In hospitals reporting to the NCDB, volume was associated with improved mortality after RC. These associations appear to be driven by hospital- rather than surgeon-level effects. An elevated SV had a beneficial effect on mortality at the highest-volume hospitals. These findings inform efforts to regionalize complex surgical care and improve quality at community and safety net hospitals.
Notes
Waingankar, Nikhil Mallin, Katherine Smaldone, Marc Egleston, Brian L Higgins, Andrew Winchester, David P Uzzo, Robert G Kutikov, Alexander eng England 2017/02/14 06:00 BJU Int. 2017 Aug;120(2):239-245. doi: 10.1111/bju.13804. Epub 2017 Mar 10.