Improved Outcomes with Higher Volumes for Radical Cystectomy
According to an early online publication in the Journal of Urology, patients with bladder cancer who undergo surgery to remove their bladder have improved outcomes if they receive treatment at a medical center where large volumes of these procedures are performed.
The bladder is a hollow organ located in the pelvis. Its primary function is to store urine (the waste produced when the kidneys filter the blood). Urine enters the bladder through two tubes called ureters and leaves the bladder through a single tube called the urethra. The bladder has a muscular wall that allows it to get larger and smaller as urine is stored or emptied.
Bladder cancer is diagnosed in roughly 50,000 men and 17,000 women annually in the U.S. Bladder cancer is most common in older individuals, with more than 70% of cases diagnosed after the age of 65.
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.
Researchers from Vanderbilt have recently conducted a clinical study to evaluate data regarding a potential relationship between outcomes of patients undergoing a radical cystectomy (removal of the bladder) and the number of these procedures performed at the medical facility where they are treated. The data was obtained from the University HealthSystem Consortium Clinical Database. All institutions were categorized as “academic.” Data included 6,728 patients with bladder cancer who had undergone a radical cystectomy between 2002 and 2007.
- The mortality rate for patients undergoing a radical cystectomy was .54% for those treated in a facility performing more than 50 radical cystectomies per year, compared with 2.7% for those treated in a facility performing 10 or less procedures per year.
- Total hospital discharges or geographic region had no effect on patient outcomes.
The researchers concluded that these results provide further evidence that outcomes are improved among patients with various types of cancers undergoing procedures or treatment in medical facilities that perform a high volume of the same procedures. Patients who are to undergo a radical cystectomy may wish to speak with their surgeon regarding the number of procedures their medical institution performs annually.
Reference: Barbieri CE, Lee B, Cookson MS, et al. Association of procedure volume with radical cystectomy outcomes in a nationwide data base. The Journal of Urology [early online publication]. July 27, 2007.