442 REGIONALIZATION OF RADICAL CYSTECTOMY: TRENDS BY HOSPITAL VOLUME 1996–2009 USING STATE DISCHARGE DATA (2011)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 2011442 REGIONALIZATION OF RADICAL CYSTECTOMY: TRENDS BY HOSPITAL VOLUME 1996–2009 USING STATE DISCHARGE DATA Marc Smaldone, Jay Simhan, Alexander Kutikov, Daniel Canter, Matthew Nielsen, Karyn Stitzenberg, Russell Starkey, Fang Zhu, Richard Greenberg, and Robert Uzzo Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author , Jay SimhanJay Simhan Philadelphia, PA More articles by this author , Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author , Daniel CanterDaniel Canter Philadelphia, PA More articles by this author , Matthew NielsenMatthew Nielsen Chapel Hill, NC More articles by this author , Karyn StitzenbergKaryn Stitzenberg Chapel Hill, NC More articles by this author , Russell StarkeyRussell Starkey Philadelphia, PA More articles by this author , Fang ZhuFang Zhu Philadelphia, PA More articles by this author , Richard GreenbergRichard Greenberg Philadelphia, PA More articles by this author , and Robert UzzoRobert Uzzo Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.533AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Centralization of complex urologic oncology procedures to high volume centers has been proposed as a means of improving surgical quality of care. We hypothesized that performance of radical cystectomy has become increasingly regionalized to very high volume hospitals resulting in improved short term clinical and mortality outcomes. METHODS Using 1996 to 2009 hospital discharge data from NY, NJ, and PA provided by Databay Resources, all patients ≥18 years with transitional cell carcinoma undergoing cystectomy were identified using ICD-9 coding. We assigned hospital volume status by quintiles based on relative proportions of radical cystectomies performed on a per hospital basis in 1996; very low volume hospital: 0–2 (VLVH), low: 3–4 (LVH), moderate: 5–8 (MVH), high: 9–31 (HVH) and very high: ≥ 32 (VHVH). Changes in the relative proportion of procedures performed by hospital volume status were assessed over time, and patient characteristics were compared between groups. Outcome variables including discharge status, inpatient mortality, and hospital length of stay (HLOS) were examined by hospital volume status using logistic regression models. RESULTS 14,404 patients undergoing cystectomy were included for analysis. From 1996 to 2009, there was a significant shift towards regionalization of care to VHVHs (21 to 38%, p=0.02) and away from VLVHs (20 to 9%, p<0.001). For each year increase (1996–2009), the odds of having surgery performed at a VHVH increased by 16% (OR 1.16 [CI 1.03, 1.31]). Stratified by hospital volume status, there were significant differences between groups in patient age (p<0.0001), race (p<0.0001), gender (p<0.0001), geographic location (p<0.0001), and payer group (p<0.0001). Independent of year treated, patients undergoing surgery at a VHVH were less likely to be African American (OR 0.50 [CI 0.32–0.79]) or insured through Medicaid (OR 0.67 [CI 0.47–0.95]) or Medicare (OR 0.84 [CI 0.76–0.95]). Controlling for year treated, median LOS was shorter (median difference −1.1 days [CI −1.12 to −1.06]) and patients were less likely to die during their hospital stay if treated at a VHVH compared to a VLVH (OR 0.30 [CI 0.17–0.52]). CONCLUSIONS Since 1996, these data demonstrate that there has been extensive centralization of radical cystectomy to VHVHs, which has resulted in significant reductions in inpatient mortality rates and HLOS over time. Nevertheless, insurer and racial disparities preclude optimal access to care and these discrepancies must still be addressed. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e180 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marc Smaldone Philadelphia, PA More articles by this author Jay Simhan Philadelphia, PA More articles by this author Alexander Kutikov Philadelphia, PA More articles by this author Daniel Canter Philadelphia, PA More articles by this author Matthew Nielsen Chapel Hill, NC More articles by this author Karyn Stitzenberg Chapel Hill, NC More articles by this author Russell Starkey Philadelphia, PA More articles by this author Fang Zhu Philadelphia, PA More articles by this author Richard Greenberg Philadelphia, PA More articles by this author Robert Uzzo Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...