Defining the minimum hospital case-load to achieve optimum outcomes in radical cystectomy
Article first published online: 9 SEP 2005
Volume 96, Issue 6, pages 806–810, October 2005
How to Cite
McCabe, J. E., Jibawi, A. and Javle, P. (2005), Defining the minimum hospital case-load to achieve optimum outcomes in radical cystectomy. BJU International, 96: 806–810. doi: 10.1111/j.1464-410X.2005.05717.x
- Issue published online: 9 SEP 2005
- Article first published online: 9 SEP 2005
- Accepted for publication 5 May 2005
- radical cystectomy;
- urological cancer;
- HES data;
- volume-outcome relationship
To define ‘high-’ and ‘low-’ volume hospitals for radical cystectomy, and the minimum caseload required for a hospital to achieve optimum outcomes, as a relationship between increasing surgical case volume and improved outcomes in radical urological surgery has been suggested in recent North American studies.
All cystectomies for urological cancer in England over 5 years were analysed from Hospital Episode Statistics (HES) data. The data were analysed statistically to describe the relationship between each hospital's annual case volume and two outcome measures: in-hospital mortality rate (MR) and hospital stay.
In all, there were 6317 cystectomies in 210 centres, with an overall MR of 5.6%. There was a significant inverse correlation (−0.733, P < 0.01) between hospital case volume and MR. Applying 95% confidence intervals, the minimum caseload required to achieve optimum outcomes was 11 procedures/year. Increasing the caseload beyond this minimum did not produce a significant reduction in MR.
Analysis of HES data confirms an inverse relationship between hospital caseload and mortality for radical cystectomy. A caseload of 11 operations/year is associated with the lowest MR.