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AUA 2019

AUA 2019: Radical Cystectomy Accessibility Challenges Associated with Hospital Volume

Chicago, IL (UroToday.com) More than 7,000 radical cystectomies (RC) are performed annually, but the operation and postoperative recovery are complex and associated with significant morbidity. Prior studies have demonstrated that patients who undergo RC at high-volume centers have improved outcomes including shorter length of stay and lower complication and mortality rates. Access to care at high-volume centers may be significantly impacted by socioeconomic factors, and the aim of this study is to analyze the impact of RC centralization on patient demographics based on provider and facility volume groupings.

The authors queried the Statewide Planning and Research Cooperative System (SPARCS) database which is an all-payer statewide reporting system maintained by the New York State Department of Health. All patients who underwent RC between 2009-2014 were found using the associated ICD code. Patient level data including socioeconomic factors (median income and source of payment) were collected. Hospital level data including location, teaching status, faculty number were collected. The primary outcomes of interest were socioeconomic factors and hospital factors. Secondary outcomes included in-hospital mortality and 30-day readmission rates.

The providers and facilities were divided into strata by volume. Continuous and categorical variables were compared between cohorts.

Of 3967 cases, 987 (25%) were performed at low-volume centers, 965 (24%) were at medium-volume centers, 1002 (25%) at high-volume centers, and 1013 (26%) at very high-volume centers. They found that volume was significantly associated with age, race, ethnicity, Charlson comorbidity index (CCI), median income and source of payment (p<0.001). They found that the very high-volume strata were associated with more Caucasian patients, higher CCI, higher median income, and increased number of insured patients.

In conclusion, socioeconomic factors play a role in the performance of RC at high-volume centers which may have implications for outcomes. African-American and Medicaid patients were found to be concentrated in low-volume centers and low-volume surgeons. Centralization of RC may contribute to these disparities.


Presented by: Olamide Omidele, Department of Chemical Engineering, Columbia University, New York, New York, United States

Written by: Selma Masic, MD, Urologic Oncology Fellow (SUO), Fox Chase Cancer Center, @selmasic at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois