Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/18952
Title: Hospital volume and perioperative outcomes for radical cystectomy: a population study.
Austin Authors: Udovicich, Cristian;Perera, Marlon ;Huq, Molla;Wong, Lih-Ming ;Lenaghan, Daniel
Affiliation: Department of Urology, St Vincent's Hospital, Melbourne, Victoria, Australia
Department of Surgery, Western Health, Melbourne, Victoria, Australia
Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia
Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
Department of Surgery, Mildura Base Hospital, Mildura, Victoria, Australia
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Issue Date: May-2017
Publication information: BJU International 2017; 119 Suppl 5: 26-32
Abstract: To evaluate the association between hospital volume and perioperative outcomes of radical cystectomy (RC) using state population data for a contemporary Australian cohort. Patients undergoing RC for urothelial malignancy in the state of Victoria, Australia between July 2003 and June 2014 were identified using the Victorian Admitted Episodes Dataset (VAED). Hospitals were divided into tertiles according to their caseload per year. Hospitals performing <4 RCs/year were defined as low-volume hospitals (LVH), 4-10 RCs/year as medium-volume hospitals (MVH), and >10 RCs/year as high-volume hospitals (HVH). Perioperative outcomes derived included: in-hospital mortality (IHM), prolonged length of stay (LOS; >14 days), prolonged intensive care unit (ICU) admission (>24 h), and requirement for blood transfusion. The relationship between hospital volume and perioperative outcomes was assessed using logistic regression. During the 11-year study period, 803 patients underwent RC for bladder cancer. The overall IHM rate was 2.2% (LVH 3.7%, MVH 2.5%, HVH 0.9%). Other outcomes observed were prolonged LOS (45%), prolonged ICU admission (31%) and requirement for blood transfusion (56%). On multivariate analysis, LVH was found to be associated with increased IHM (odds ratio [OR] 5.74, P = 0.04) and prolonged ICU admission (OR 11.58, P < 0.001) when compared to HVH. There was a lower rate of prolonged LOS for LVH (OR 0.60, P = 0.01). No significant relationship was identified for LVH and blood transfusion. Perioperative outcomes in Victoria are comparable to international standards. Our results add further population study evidence to the volume-outcome relationship in RC. There was a significant association between LVH and both IHM and prolonged ICU admission. This subgroup of patients would appear to benefit from transfer of care to a HVH. The role of centralisation of RC in Australia should be further considered.
URI: https://ahro.austin.org.au/austinjspui/handle/1/18952
DOI: 10.1111/bju.13827
ORCID: 0000-0002-1138-6389
Journal: BJU International
PubMed URL: 28544301
Type: Journal Article
Subjects: bladder cancer
hospital volume
morbidity
mortality
radical cystectomy
Appears in Collections:Journal articles

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