Effect of Hospital and Surgeon Case Volume on Perioperative Quality of Care and Short-term Outcomes After Radical Cystectomy for Muscle-invasive Bladder Cancer: Results From a European Tertiary Care Center Cohort

Vetterlein, Malte W. ; Meyer, Christian P. ; Leyh-Bannurah, Sami-Ramzi ; Mayr, Roman ; Gierth, Michael ; Fritsche, Hans-Martin ; Burger, Maximilian ; Keck, Bastian ; Wullich, Bernd ; Martini, Thomas ; Bolenz, Christian ; Pycha, Armin ; Hanske, Julian ; Roghmann, Florian ; Noldus, Joachim ; Bastian, Patrick J. ; Gilfrich, Christian ; May, Matthias ; Rink, Michael ; Chun, Felix K.-H. ; Dahlem, Roland ; Fisch, Margit ; Aziz, Atiqullah ; Bartsch, Georg ; Brookman-May, Sabine ; Buchner, Alexander ; Durschnabel, Melanie ; Ellinger, Jörg ; Froehner, Michael ; Georgieva, Galia ; Gördük, Murat ; Grimm, Marc-Oliver ; Hadaschik, Boris ; Haferkamp, Axel ; Hakenberg, Oliver W. ; Hartmann, Florian ; Herrmann, Edwin ; Hertle, Lothar ; Hohenfellner, Markus ; Janetschek, Georg ; Kraischits, Nicole ; Krausse, Annerose ; Lusuardi, Lukas ; Michel, Maurice S. ; Moritz, Rudolf ; Müller, Stefan C. ; Novotny, Vladimir ; Nuhn, Philipp ; Pahernik, Sascha ; Palisaar, Rein-Jüri ; Ponholzer, Anton ; Protzel, Chris ; Roigas, Jan ; Schmid, Marianne ; Schramek, Paul ; Seitz, Christian ; Sikic, Danijel ; Stief, Christian G. ; Syring, Isabella ; Vallo, Stefan ; Wagenlehner, Florian M. ; Weidner, Wolfgang ; Wirth, Manfred P.

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Alternative Links zum Volltext:DOIVerlag

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Details

Dokumentenart:	Artikel
Titel eines Journals oder einer Zeitschrift:	Clinical Genitourinary Cancer
Verlag:	CIG MEDIA GROUP, LP
Ort der Veröffentlichung:	DALLAS
Band:	15
Nummer des Zeitschriftenheftes oder des Kapitels:	5
Seitenbereich:	e809-e817
Datum:	2017
Institutionen:	Medizin > Lehrstuhl für Urologie
Identifikationsnummer:	Wert Typ 10.1016/j.clgc.2017.04.021 DOI
Stichwörter / Keywords:	OPERATIVE MORTALITY; 90-DAY MORTALITY; UNITED-STATES; COMPLICATIONS; ASSOCIATION; RECOVERY; High volume; Postoperative complications; Quality of health care; Urinary bladder neoplasms; Volume-outcome relationship
Dewey-Dezimal-Klassifikation:	600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin
Status:	Veröffentlicht
Begutachtet:	Ja, diese Version wurde begutachtet
An der Universität Regensburg entstanden:	Ja
Dokumenten-ID:	39700

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Zusammenfassung

This prospective multicenter study analyzed the effect of hospital and surgeon case volume on perioperative quality of care and short-term complications and mortality in 479 patients undergoing radical cystectomy for bladder cancer. We found that hospital volume might represent an at least equally important factor regarding postoperative complications as the surgeon case volume itself at European ...

Zusammenfassung

This prospective multicenter study analyzed the effect of hospital and surgeon case volume on perioperative quality of care and short-term complications and mortality in 479 patients undergoing radical cystectomy for bladder cancer. We found that hospital volume might represent an at least equally important factor regarding postoperative complications as the surgeon case volume itself at European tertiary care centers. Background Case volume has been suggested to affect surgical outcomes in different arrays of procedures. We aimed to delineate the relationship between case volume and surgical outcomes and quality of care criteria of radical cystectomy (RC) in a prospectively collected multicenter cohort. Patients and Methods This was a retrospective analysis of a prospectively collected European cohort of patients with bladder cancer treated with RC in 2011. We relied on 479 and 459 eligible patients with available information on hospital case volume and surgeon case volume, respectively. Hospital case volume was divided into tertiles, and surgeon volume was dichotomized according to the median annual number of surgeries performed. Binomial generalized estimating equations controlling for potential known confounders and inter-hospital clustering assessed the independent association of case volume with short-term complications and mortality, as well as the fulfillment of quality of care criteria. Results The high-volume threshold for hospitals was 45 RCs and, for high-volume surgeons, was > 15 cases annually. In adjusted analyses, high hospital volume remained an independent predictor of fewer 30-day (odds ratio, 0.34; P = .002) and 60- to 90-day (odds ratio, 0.41; P = .03) major complications but not of fulfilling quality of care criteria or mortality. No difference between surgeon volume groups was noted for complications, quality of care criteria, or mortality after adjustments. Conclusion The coordination of care at high-volume hospitals might confer a similar important factor in postoperative outcomes as surgeon case volume in RC. This points to organizational elements in high-volume hospitals that enable them to react more appropriately to adverse events after surgery. (C) 2017 Elsevier Inc. All rights reserved.

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