Mortality After Urologic Cancer Surgery: Impact of Non-index Case Volume - 08/08/11
Reprint requests: Brent K. Hollenbeck, M.D., M.S., University of Michigan Medical Center, Department of Urology, Taubman Center 3875, Box 0330, 1500 East Medical Center Drive, Ann Arbor, MI 48109.Abstract |
Objectives |
To quantify the degree to which overall urologic oncology volume either reduces or enhances the effect of single procedure volume on short-term outcomes after urologic oncology surgery.
Methods |
Urologic oncology procedures for prostate, kidney, and bladder cancer performed between 1988 and 2003 were identified in the Nationwide Inpatient Sample. Procedure-specific volume and urologic oncology volume (excluding the procedure of interest) were determined for each cancer and each hospital. Multivariable logistic regression models were constructed to measure the independent effect of urologic oncology volume (non-index procedures) on operative mortality after prostatectomy, cystectomy, and nephrectomy (index procedures) after adjusting for patient and hospital factors.
Results |
Unadjusted operative mortality for prostatectomy, cystectomy, and nephrectomy was 0.2%, 2.8%, and 1.4%, respectively. For prostatectomy and cystectomy, the magnitude of the volume–mortality association was reduced after adjusting for non-index urologic oncology case volume. For example, the relationship between surgical volume and mortality was reduced by 20% for radical prostatectomy and 60% for radical cystectomy.
Conclusions |
The volume–outcome effect for index urologic oncology procedures is modified by experience with other non-index specialty-related procedures. Efforts to identify transferable, effective processes of care should focus on a subset of high-volume centers.
Le texte complet de cet article est disponible en PDF.Plan
| S.M. Gilbert is supported in part by a grant from the American Urological Association Foundation. B.K. Hollenbeck is supported in part by grants from the American Cancer Society and the American Urological Association Foundation. |
Vol 71 - N° 5
P. 906-910 - mai 2008 Retour au numéro
Article précédent
- The Effect of Erectile Function on the Use of Phosphodiesterase-5 Inhibitors After Radical Prostatectomy in Japanese and U.S. Men
- Shunichi Namiki, Lorna Kwan, Marjorie Kagawa-Singer, Yoichi Arai, Mark S. Litwin
- Delayed Orchiectomy at Postchemotherapy Retroperitoneal Lymph Node Dissection Due to Laterality of Retroperitoneal Metastatic Pattern Consistent with Testicular Primary: Assessment of Pathologic Findings
- James A. Brown, Richard Bihrle, Richard S. Foster
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?