MP08-10 TRENDS IN REGIONALIZATION OF CARE AND MORTALITY FOR PATIENTS TREATED WITH RADICAL CYSTECTOMY

Field: Medicine (Health Sciences)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II1 Apr 2016MP08-10 TRENDS IN REGIONALIZATION OF CARE AND MORTALITY FOR PATIENTS TREATED WITH RADICAL CYSTECTOMY Nikhil Waingankar, Katherine Mallin, Brian Egleston, Robert Uzzo, Alexander Kutikov, David Winchester, and Marc Smaldone Nikhil WaingankarNikhil Waingankar More articles by this author , Katherine MallinKatherine Mallin More articles by this author , Brian EglestonBrian Egleston More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , David WinchesterDavid Winchester More articles by this author , and Marc SmaldoneMarc Smaldone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2255AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Regionalization to higher volume centers has been proposed as a mechanism to improve short-term outcomes following complex surgery. Our objective was to assess trends in regionalization and mortality for patients undergoing radical cystectomy (RC). METHODS Data from 2004-2013 were extracted from the National Cancer Database (NCDB). Hospitals performing at least one RC in any of the 10 diagnosis years were included in the analysis, and diagnosis years were grouped into two-year intervals. Trends in the percent distribution of cystectomies by hospital volume were assessed, as were 30- and 90-day mortality. Low-volume hospitals (LVH) were defined as those that performed <= 5 RC/year, and high-volume hospitals (HVH) were defined as those that performed >=30/year. Tests for trend were performed for volume and unadjusted mortality between 2004-2013, and Propensity Score weighted Proportional Hazard regression models were used in the analysis of mortality trends, adjusting for demographic and clinical variables. RESULTS 47,028 cystectomies were performed in 1,162 hospitals that reported patients to the NCDB in each of the diagnosis years. The proportion of patients undergoing RC at LVHs declined from 29% to 17% (p<0.01), while the proportion treated at HVHs significantly increased from 16% to 33% (p< .01) over the study period. For all hospitals, unadjusted 30 day (3.0 to 2.5%, p=0.02) and 90 day (8.2 to 7.3%, p<0.001) mortality decreased from 2004-2013. Stratified by volume, the absolute decrease in 30-day mortality was greatest at LVHs (-1.8%; 4.6 vs. 2.8%, p=0.04) while rates for HVHs remained stable (-0.5%, 1.9 vs. 1.4%, p=0.33). In comparison, the absolute difference in 90-day mortality rates was more demonstrable for patients treated at HVHs (-1.9%, 6.3 vs. 4.4%, p=0.05) compared to those treated at LVHs (-1.2%, 9.9 vs. 8.7%, p=0.16). Following risk-adjustment, treatment at a LVH was associated with increased 30-day (HR 1.6 [CI 1.4-1.9]) and 90-day mortality (HR 1.4 [CI 1.3-1.5]) compared to patients treated at a HVH. CONCLUSIONS In hospitals reporting to the NCDB, regionalization of RC to HVHs was observed from 2004-2013. Adjusting for confounding, treatment at a low volume facility was associated with a 60% increase in 30-day mortality and 40% increase in 90-day mortality compared to those treated at high volume hospitals. While these findings support selective referral of complex cases to higher volume centers, further study to identify processes of care associated with improved mortality outcomes is required. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e88 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Nikhil Waingankar More articles by this author Katherine Mallin More articles by this author Brian Egleston More articles by this author Robert Uzzo More articles by this author Alexander Kutikov More articles by this author David Winchester More articles by this author Marc Smaldone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...