Benefit in regionalisation of care for patients treated with radical cystectomy: a nationwide inpatient sample analysis. (5th September 2013)

• Record Type: Journal Article
• Authors: Ravi, Praful; Bianchi, Marco; Hansen, Jens; Trinh, Quoc‐Dien; Tian, Zhe; Meskawi, Malek; Abdollah, Firas; Briganti, Alberto; Shariat, Shahrokh F.; Perrotte, Paul; Montorsi, Francesco; Karakiewicz, Pierre I.; Sun, Maxine
• Is Part Of: BJU international. Volume 113:Number 5(2014:May)
• Page Start: 733
• Page End: 740
• Publication Date: 2013-09-05
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12288
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12288-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju12288-list-0001" list-type="bullet"> <list-item> <p>To quantify in absolute terms the potential benefit of regionalisation of care from low‐ to high‐volume hospitals.</p> </list-item> </list> </p> </sec> <sec id="bju12288-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12288-list-0002" list-type="bullet"> <list-item> <p>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.</p> </list-item> <list-item> <p>Intraoperative and postoperative complications, blood transfusions, prolonged length of stay, and in‐hospital mortality rates represented the outcomes of interest.</p> </list-item> <list-item> <p>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).</p> </list-item> <list-item> <p>Multivariable logistic regression models and number needed to treat were generated.</p> </list-item> </list> </p> </sec> <sec id="bju12288-sec-1002" sec-type="section"> <title>Results</title> <p> <list id="bju12288-list-0003" list-type="bullet"> <list-item> <p>Patients treated at high‐volume hospitals had lower odds of complications during hospitalisation than those treated in low‐volume hospitals.</p> </list-item> <list-item> <p>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.</p> </list-item> <list-item> <p>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.</p> </list-item> </list> </p> </sec> <sec id="bju12288-sec-0003" sec-type="section"> <title>Conclusion</title> <p> <list id="bju12288-list-0004" list-type="bullet"> <list-item> <p>This is the first report to quantify the potential benefit of regionalisation of RC for muscle‐invasive bladder cancer to high‐volume hospitals.</p> </list-item> </list> </p> </sec> </abstract>