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Radical nephrectomy surgical outcomes in the University HealthSystem Consortium Data Base: Impact of hospital case volume, hospital size, and geographic location on 40,000 patients.

Abstract：

BACKGROUND:We sought to determine the impact of radical nephrectomy case volume, hospital size, and geographic region on immediate surgical outcomes for patients undergoing radical nephrectomy in academic centers across the country. METHODS:The University HealthSystem Consortium (UHC) Clinical Data Base was queried for data corresponding to patients who underwent radical nephrectomy at 1 of 134 academic medical centers nationwide between 2003 and quarter 2 of 2007 (n = 42,988). Radical nephrectomy case volume (1-99, 100-499, and 500 +), total discharges (1-49,999, 50,000-99,999, 100,000 +), and geographic region (5 categories) were determined for each academic center. ANOVA and the Tukey statistic were used. Length of stay, intensive care unit (ICU) rate, complication (comp) rate, and in-hospital mortality were analyzed. RESULTS:Case volume was a significant predictor of length of stay, ICU, and comp. Mean length of stay was 6.88, 5.61, and 4.76 days, respectively, for centers from lowest to highest case volumes (P < .001). ICU rates for the 3 tiers were 30.77, 17.93, and 12.22 (P < .001). Comp rates were 24.50, 19.40, and 15.48 (P < .001). Tukey analysis revealed a ceiling effect: No differences were seen between the 2 higher case volume groups. Stratification by total discharges revealed differences in ICU rates (P = .001) and comp rates (P = .001). Region of the country had no significant impact on any of the outcome variables in this study. CONCLUSIONS:Radical nephrectomy case volume emerged as an important variable in predicting 3 of the 4 outcome parameters in this study. Results suggest that a "critical volume" of cases portends improved surgical outcomes.

journal_name

Cancer

journal_title

Cancer

authors

Mitchell RE,Lee BT,Cookson MS,Barocas DA,Duke Herrell S,Clark PE,Smith JA,Chang SS

doi

10.1002/cncr.24292

subject

Has Abstract

pub_date

2009-06-01 00:00:00

pages

2447-52

issue

eissn

0008-543X

issn

1097-0142

journal_volume

115

pub_type

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Radical nephrectomy surgical outcomes in the University HealthSystem Consortium Data Base: Impact of hospital case volume, hospital size, and geographic location on 40,000 patients.