San Diego, CA USA (UroToday.com) An interesting poster was presented in today’s epidemiology and evaluation session at the AUA 2016 evaluating the Trends in Regionalization of Care and Mortality for Patients Treated with Radical Cystectomy. Dr Nikhil Waingankar reminded all that the association between surgical volume and mortality is already established. However the benefits of regionalization are not equally extended to all patients.
The authors sought to examine Trends in Regionalization of Care and Mortality for Patients Treated with Radical Cystectomy. The authors examined all cystectomies between 2004 and 2013 in the NCDB. All institutions were divided according to the cystectomy volume (with high and low volume institutes defined as less than 5 or more than 30 cystectomies per year respectively). Mortality trends were examined with the cox proportional model after adjusting with a propensity score. 1162 institutes were included in the study. Over the study period the proportion of patients treated in low or high volume center changed from 29% to 17% and 16 to 33% respectively, both statistically significant. Furthermore, the mortality rates decreased in all types of institutions. However, after risk-adjustment, treatment at a low volume center was associated with increased 30-day and 90-day mortality compared to patients treated at a high volume center. The authors concluded that the regionalization to high volume centers for cystectomy was prominent in the study period. That may explain the fact that treatment at a low volume center was associated with an increased 30-day and 90-day mortality compared to those treated at high volume hospitals.
Presented By: Nikhil Waingankar, MD.
Written by: Miki Haifler, MD., Fox Chase Cancer Center, Philadelphia, PA. from the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA.