Benefit in regionalisation of care for patients treated with radical cystectomy: a nationwide inpatient sample analysis.

Abstract:

OBJECTIVE:To quantify in absolute terms the potential benefit of regionalisation of care from low- to high-volume hospitals. PATIENTS AND METHODS: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. Intraoperative and postoperative complications, blood transfusions, prolonged length of stay, and in-hospital mortality rates represented the outcomes of interest. 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). Multivariable logistic regression models and number needed to treat were generated. RESULTS:Patients treated at high-volume hospitals had lower odds of complications during hospitalisation than those treated in low-volume hospitals. 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. 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. CONCLUSION:This is the first report to quantify the potential benefit of regionalisation of RC for muscle-invasive bladder cancer to high-volume hospitals.

journal_name

BJU Int

journal_title

BJU international

authors

Ravi P,Bianchi M,Hansen J,Trinh QD,Tian Z,Meskawi M,Abdollah F,Briganti A,Shariat SF,Perrotte P,Montorsi F,Karakiewicz PI,Sun M

doi

10.1111/bju.12288

subject

Has Abstract

pub_date

2014-05-01 00:00:00

pages

733-40

issue

5

eissn

1464-4096

issn

1464-410X

journal_volume

113

pub_type

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