Benefit in regionalisation of care for patients treated with radical cystectomy: a nationwide inpatient sample analysis.

Abstract

OBJECTIVE:

To quantify in absolute terms the potential benefit of regionalisation of care from low- to high-volume hospitals.

PATIENTS AND METHODS:

Patients with a primary diagnosis of bladder cancer treated with radical cystectomy (RC) were identified within the Nationwide Inpatient Sample, a retrospective observational population-based cohort of the USA, between 1998 and 2009. Intraoperative and postoperative complications, blood transfusions, prolonged length of stay, and in-hospital mortality rates represented the outcomes of interest. Potentially avoidable outcomes were calculated by subtracting predicted rates (i.e. estimated outcomes if care was delivered at a high-volume hospital) from observed rates (i.e. actual observed outcomes after care delivered at a low-volume hospital). Multivariable logistic regression models and number needed to treat were generated.

RESULTS:

Patients treated at high-volume hospitals had lower odds of complications during hospitalisation than those treated in low-volume hospitals. Potentially avoidable intraoperative complications, postoperative complications, blood transfusions, prolonged hospitalisation, and in-hospital mortality rates were 0.6, 7.4, 2.8, 9.4, and 2.0%, respectively. This corresponds to a number needed to redirect from low- to high-volume hospitals in order to avoid one adverse event of 166, 14, 36, 11 and 50, respectively.

CONCLUSION:

This is the first report to quantify the potential benefit of regionalisation of RC for muscle-invasive bladder cancer to high-volume hospitals.

• Authors: Praful Ravi, Marco Bianchi, Jens Hansen, Quoc-Dien Trinh, Zhe Tian, Malek Meskawi, Firas Abdollah, Alberto Briganti, Shahrokh F Shariat, Paul Perrotte, Francesco Montorsi, Pierre I Karakiewicz, Maxine Sun
• Journal: BJU international (BJU Int) Vol. 113 Issue 5 Pg. 733-40 (May 2014) ISSN: 1464-410X [Electronic] England
• PMID: 24007240 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 The Authors. BJU International © 2013 BJU International.

Topics

• Aged
• Aged, 80 and over
• Cystectomy (methods)
• Female
• Follow-Up Studies
• Global Health
• Hospital Mortality (trends)
• Hospitals, High-Volume (statistics & numerical data)
• Hospitals, Low-Volume (statistics & numerical data)
• Humans
• Incidence
• Inpatients (statistics & numerical data)
• Intraoperative Complications (epidemiology)
• Length of Stay (trends)
• Logistic Models
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Retrospective Studies
• Urinary Bladder Neoplasms (mortality, surgery)