High-Volume Hospitals Offer Better Outcomes for Radical Cystectomy
by Dr. C.H. Weaver M.D. (07/2018)
Among patients undergoing radical cystectomy (removal of bladder) or radical prostatectomy (removal of prostate), the probability of dying during hospitalization was lower at hospitals that performed a greater number of these specific procedures (high-volume hospitals). Hospital volume was not linked with in-hospital mortality after radical nephrectomy (removal of kidney). These results were published in the Journal of Clinical Oncology.
The relationship between patient outcomes and the number of patients seen at a particular hospital or by a particular doctor has received a great deal of attention over the past 25 years. In general, studies report that “high-volume” hospitals and doctors (hospitals and doctors who treat more patients with a particular condition) have better patient outcomes for specific conditions.
To evaluate the link between various measures of hospital volume and patient outcomes after surgery for urologic cancer, researchers evaluated a database containing information from more than 1000 hospitals in the U.S. The researchers collected information about the number of in-hospital deaths after radical prostatectomy for prostate cancer, radical cystectomy for bladder cancer, or radical nephrectomy for kidney cancer.
In addition to assessing the number of prostatectomies, cystectomies, and nephrectomies performed by a particular hospital, the researchers also assessed the number of other complicated medical procedures performed. These other procedures included coronary bypass surgery, aortic aneurysm repair, pancreatic surgery, and esophageal surgery. The researchers hypothesized that hospitals with a high volume of these other complicated procedures may also have better outcomes after urologic cancer surgery.
- In-hospital death occurred in 169 out of 6,577 patients (2.6%) undergoing radical cystectomy for bladder cancer; 66 out of 61,039 patients (0.11%) undergoing radical prostatectomy for prostate cancer; and 237 out of 24,013 patients (0.99%) undergoing radical nephrectomy for kidney cancer.
- Hospitals that performed a greater number of radical cystectomies or radical prostatectomies had lower rates of in-hospital deaths after these procedures.
- The number of radical nephrectomies performed by a hospital was not linked with the rate of in-hospital death after radical nephrectomy.
- The number of other complicated medical procedures performed by a hospital did not influence the rate of in-hospital death after radical cystectomy, radical prostatectomy, or radical nephrectomy.
The researchers conclude that in-hospital mortality after radical cystectomy or radical prostatectomy was lower in hospitals that performed a greater number of these specific procedures.
Reference: Konety BR, Allareddy V, Modak S et al. Mortality After Major Surgery for Urologic Cancers in Specialized Urology Hospitals: Are They Any Better? Journal of Clinical Oncology. 2006;24:2006-2012.