San Diego, CA USA (UroToday.com) A very interesting poster was presented in today’s epidemiology and evaluation session at the AUA 2016 evaluating the relative contribution of hospital and surgeon volume on short term mortality outcomes following radical cystectomy. Dr Nikhil Waingankar reminded all that the association between surgical volume and mortality is already established.
However, the relative contribution of hospital versus surgeon’s experience in not well elucidated. The authors sought to examine this very interesting point by examining the National Cancer Database (NCDB). The authors examined all cystectomies between 2010 and 2013 and calculated the volume of the surgeons and the hospital separately. A propensity score was used to created match volume groups and a proportional hazard model was used to compare the different 90 days survival rates in the different groups. Median hospital and surgeon volume were 4.3 (range 0.3-121.8) and 12.3 (0.3-63) cases, respectively. 30 day mortality was 3.4% in centers with <5 cases/year and 1.9% in those with >30 cases/year (p<0.0001).same rates were found for surgeons. When examining the combined effect of surgeon and hospital volume influence on mortality the authors found that the hospital volume is more important. Increased surgeons volume provided a beneficial effect on mortality only at the highest volume hospitals. The greatest benefit was achieved for both high hospital and surgeon volumes.
Presented By: Nikhil Waingankar, MD FOx Chase Cancer Center at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California