Trends in Regionalization of Care and Mortality For Patients Treated With Radical Cystectomy
Bibliographic Data
| ID | 9101582 |
|---|---|
| Authors | Nikhil Waingankar (0000-0003-4703-0074, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY, corresponding author), Katherine Mallin (0000-0001-9663-5702, American College of Surgeons), Brian L Egleston (0000-0002-1633-799X, Fox Chase Cancer Center, Philadelphia, PA), David P Winchester (American College of Surgeons), Robert G Uzzo (0000-0003-2398-6530, Fox Chase Cancer Center, Philadelphia, PA), Alexander Kutikov (0000-0003-1525-6247, Fox Chase Cancer Center, Philadelphia, PA), Marc C Smaldone (0000-0003-4160-0005, Fox Chase Cancer Center, Philadelphia, PA) |
| Year | 2019 |
| Volume | 57 |
| Issue | 9 |
| Pages | 728-733 |
| Publication date | 2019-09-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000001143 |
| PMID | 31313685 |
| OpenAlex | W2961485856 |
| Language | EN |
| References cited | 40 |
BACKGROUND: Regionalization to higher volume centers has been proposed as a mechanism to improve short-term outcomes following complex surgery. OBJECTIVE: The objective of this study was to assess trends in regionalization and mortality for patients undergoing radical cystectomy (RC). RESEARCH DESIGN: An observational study of patients receiving RC in the United States from 2004 to 2013. SUBJECTS: Data for patients receiving RC were extracted from the National Cancer Database. MEASURES: The primary exposure was hospital volume; low-volume hospitals (LVH) included those with <5 RC/year and high-volume hospitals (HVH) were those with ≥30 RC/year. Trends in the volume were assessed, as were 30- and 90-day mortality. Cochrane-Armitage tests were performed for volume, and propensity score-weighted proportional hazard regression was used to assess mortality. RESULTS: A total of 47,028 RC were performed in 1162 hospitals from 2004 to 2013. The proportion of RC at LVH declined from 29% to 17% (P<0.01), whereas that of HVH increased from 16% to 33% (P<0.01). Unadjusted 30- (P=0.02) and 90-day (P<0.001) mortality decreased, and the absolute decrease was greatest at LVH (4.8% vs. 2.6%, P=0.03), whereas rates for HVH remained stable (1.9% vs. 1.4%, P=0.34). Following risk-adjustment, relative to treatment at HVH, treatment at LVH was associated with increased 30-day (hazard ratio: 1.66, 95% CI: 1.53-1.80) and 90-day mortality (hazard ratio: 1.37, 95% confidence interval: 1.30-1.44). CONCLUSIONS: Regionalization of RC to HVH was observed from 2004 to 2013. Treatment at LVH was associated with 66% and 33% relative increases in hazard of death at 30 and 90 days, respectively. These findings support the selective referral of complex cases to higher volume centers
Bladder cancer · Cancer · Confidence interval · Cystectomy · Hazard ratio · Mortality rate · Proportional hazards model · Bladder and Urothelial Cancer Treatments · Demography · Internal Medicine · Medicine · Surgery · Urinary and Genital Oncology Studies · Urinary Tract Infections Management
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| Citation velocity | historical |
|---|---|
| Highly cited | No |