P.R. and M.B. contributed equally to this manuscript.
Benefit in regionalisation of care for patients treated with radical cystectomy: a nationwide inpatient sample analysis
Article first published online: 5 SEP 2013
© 2013 The Authors. BJU International © 2013 BJU International
Volume 113, Issue 5, pages 733–740, May 2014
How to Cite
Ravi, P., Bianchi, M., Hansen, J., Trinh, Q.-D., Tian, Z., Meskawi, M., Abdollah, F., Briganti, A., Shariat, S. F., Perrotte, P., Montorsi, F., Karakiewicz, P. I. and Sun, M. (2014), Benefit in regionalisation of care for patients treated with radical cystectomy: a nationwide inpatient sample analysis. BJU International, 113: 733–740. doi: 10.1111/bju.12288
- Issue published online: 9 APR 2014
- Article first published online: 5 SEP 2013
- Accepted manuscript online: 13 JUN 2013 06:35AM EST
- University of Montreal Health Centre Urology Specialists
- Fonds de la Recherche en Santé du Québec
- University of Montreal Department of Surgery
- University of Montreal Health Centre (CHUM) Foundation
- radical cystectomy;
- muscle-invasive bladder cancer
- 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.
- 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.
- This is the first report to quantify the potential benefit of regionalisation of RC for muscle-invasive bladder cancer to high-volume hospitals.