One out of five patients with muscle-invasive bladder cancer undergo radical cystectomy-a guideline-recommended treatment. Previous studies have primarily evaluated patient characteristics associated with the use of radical cystectomy, ignoring potential nesting of data.
To determine the impact of patient, diagnosing urologist, and hospital characteristics on the variation in the use of radical cystectomy.
This is a retrospective cohort study using the Surveillance, Epidemiology, and End Results Registry (SEER)-Medicare linked database.
A total of 7097 muscle-invasive bladder cancer patients and 4601 diagnosing urologists affiliated to 822 hospitals from January 1, 2002 to December 31, 2012 were analyzed. Multilevel logistic regression analyses were used to determine variation and factors associated with the use of radical cystectomy.
Of the 7097 patients, only 27% underwent radical cystectomy. The intraclass correlation coefficient for variation in the use of radical cystectomy attributed to the hospital level was 4.3%. Higher radical cystectomy volume by diagnosing urologists (more than five vs zero to one surgery: odds ratio [OR], 1.27; 95% confidence interval [CI], 1.00-1.62) and hospitals (more than five vs zero to four surgeries: OR,1.48; 95% CI, 1.14-1.93) was associated with increased use of radical cystectomy. Patients diagnosed by female rather than male urologists were more likely to undergo radical cystectomy (OR, 1.32; 95% CI, 1.07-1.62).
We found that 4.3% variation in the use of radical cystectomy was attributed to the hospital level, leaving 95.7% variation in use unexplained. We identified significantly increased use among higher-volume and female diagnosing urologists. These findings support further investigation into measures beyond hospital volume, which largely impact the utilization of radical cystectomy.
In this large population-based study, we found that 4.3% of variation in the use of radical cystectomy was attributed to the hospital level, leaving 95.7% variation in use unexplained. Higher radical cystectomy volume of diagnosing urologists and female urologists were independently associated with increased use of radical cystectomy. These findings support further investigation into measures beyond hospital volume, which largely impact the utilization of radical cystectomy.
European urology open science. 2020 Jun 23*** epublish ***
Vishnukamal Golla, Yong Shan, Hemalkumar B Mehta, Zachary Klaassen, Douglas S Tyler, Jacques Baillargeon, Ashish M Kamat, Stephen J Freedland, John L Gore, Karim Chamie, Yong-Fang Kuo, Stephen B Williams
Department of Urology, University of California, Los Angeles, CA, USA., Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA., Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA., Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX, USA., Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, TX, USA., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, Cedars Sinai Medical Center, Los Angeles, CA, USA., Department of Urology, The University of Washington, Seattle, WA, USA.