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Erschienen in: Annals of Surgical Oncology 9/2011

01.09.2011 | Urologic Oncology

Surgical Caseload is an Important Determinant of Continent Urinary Diversion Rate at Radical Cystectomy: A Population-Based Study

verfasst von: Firas Abdollah, MD, Maxine Sun, BSc, Jan Schmitges, MD, Rodolphe Thuret, MD, Orchidee Djahangirian, Claudio Jeldres, MD, Zhe Tian, BSc, Shahrokh F. Shariat, MD, Paul Perrotte, MD, Francesco Montorsi, MD, Pierre I. Karakiewicz, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 9/2011

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Abstract

Background

At radical cystectomy (RC), continent urinary diversion (CUD) provides functional outcomes that most closely approximate that of a native bladder. We tested the hypothesis that patients treated at high RC caseload hospitals and/or by high RC caseload surgeons have higher CUD rates.

Methods

We identified 9,493 bladder cancer patients treated with RC between 1998 and 2007, within the Nationwide Inpatient Sample. Univariable and multivariable analyses tested the relationship between hospital and surgical caseload at RC, and CUD rate. Generalized estimating equations models were used to adjust for clustering among hospitals and surgeons.

Results

Only 8% of patients received a CUD at RC. The CUD rate was 5 vs. 7 vs. 13% for low versus intermediate versus high annual hospital caseload (AHC) tertiles (P < 0.001). The CUD rate was 6 vs. 10 vs. 16% for low versus intermediate versus high annual surgical caseload (ASC) tertiles (P < 0.001). In multivariable analyses, and after adjusting for clustering, ASC emerged as independent predictors of CUD rate (P < 0.001), while AHC failed to achieve the independent predictor status for the same end point (P ≥ 0.1).

Conclusions

Our findings indicate that CUD is performed in a minority (8%) of RC patients. Surgical caseload represents an important determinant of CUD rate, while hospital caseload failed to achieve independent predictor status. Efforts should be made to optimize CUD rate a RC.
Literatur
1.
Zurück zum Zitat Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277–300.PubMedCrossRef Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277–300.PubMedCrossRef
3.
Zurück zum Zitat Kassouf W, Hautmann RE, Bochner BH, et al. A critical analysis of orthotopic bladder substitutes in adult patients with bladder cancer: is there a perfect solution? Eur Urol. 2010;58:374–83.PubMedCrossRef Kassouf W, Hautmann RE, Bochner BH, et al. A critical analysis of orthotopic bladder substitutes in adult patients with bladder cancer: is there a perfect solution? Eur Urol. 2010;58:374–83.PubMedCrossRef
4.
Zurück zum Zitat Bjerre BD, Johansen C, Steven K. Health-related quality of life after cystectomy: bladder substitution compared with ileal conduit diversion. A questionnaire survey. Br J Urol. 1995;75:200–5.PubMedCrossRef Bjerre BD, Johansen C, Steven K. Health-related quality of life after cystectomy: bladder substitution compared with ileal conduit diversion. A questionnaire survey. Br J Urol. 1995;75:200–5.PubMedCrossRef
5.
Zurück zum Zitat Boyd SD, Feinberg SM, Skinner DG, Lieskovsky G, Baron D, Richardson J. Quality of life survey of urinary diversion patients: comparison of ileal conduits versus continent Kock ileal reservoirs. J Urol. 1987;138:1386–9.PubMed Boyd SD, Feinberg SM, Skinner DG, Lieskovsky G, Baron D, Richardson J. Quality of life survey of urinary diversion patients: comparison of ileal conduits versus continent Kock ileal reservoirs. J Urol. 1987;138:1386–9.PubMed
6.
Zurück zum Zitat Konety BR, Allareddy V, Herr H. Complications after radical cystectomy: analysis of population-based data. Urology. 2006;68:58–64.PubMedCrossRef Konety BR, Allareddy V, Herr H. Complications after radical cystectomy: analysis of population-based data. Urology. 2006;68:58–64.PubMedCrossRef
7.
Zurück zum Zitat Konety BR, Dhawan V, Allareddy V, Joslyn SA. Impact of hospital and surgeon volume on in-hospital mortality from radical cystectomy: data from the health care utilization project. J Urol. 2005;173:1695–700.PubMedCrossRef Konety BR, Dhawan V, Allareddy V, Joslyn SA. Impact of hospital and surgeon volume on in-hospital mortality from radical cystectomy: data from the health care utilization project. J Urol. 2005;173:1695–700.PubMedCrossRef
8.
Zurück zum Zitat Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117–27.PubMedCrossRef Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117–27.PubMedCrossRef
9.
Zurück zum Zitat Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128–37.PubMedCrossRef Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128–37.PubMedCrossRef
10.
Zurück zum Zitat Gore JL, Yu HY, Setodji C, Hanley JM, Litwin MS, Saigal CS. Urinary diversion and morbidity after radical cystectomy for bladder cancer. Cancer. 2010;116:331–9.PubMedCrossRef Gore JL, Yu HY, Setodji C, Hanley JM, Litwin MS, Saigal CS. Urinary diversion and morbidity after radical cystectomy for bladder cancer. Cancer. 2010;116:331–9.PubMedCrossRef
11.
Zurück zum Zitat Hu JC, Gold KF, Pashos CL, Mehta SS, Litwin MS. Temporal trends in radical prostatectomy complications from 1991 to 1998. J Urol. 2003;169:1443–8.PubMedCrossRef Hu JC, Gold KF, Pashos CL, Mehta SS, Litwin MS. Temporal trends in radical prostatectomy complications from 1991 to 1998. J Urol. 2003;169:1443–8.PubMedCrossRef
12.
Zurück zum Zitat Begg CB, Riedel ER, Bach PB, et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002;346:1138–44.PubMedCrossRef Begg CB, Riedel ER, Bach PB, et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002;346:1138–44.PubMedCrossRef
13.
Zurück zum Zitat Panageas KS, Schrag D, Riedel E, Bach PB, Begg CB. The effect of clustering of outcomes on the association of procedure volume and surgical outcomes. Ann Intern Med. 2003;139:658–65.PubMed Panageas KS, Schrag D, Riedel E, Bach PB, Begg CB. The effect of clustering of outcomes on the association of procedure volume and surgical outcomes. Ann Intern Med. 2003;139:658–65.PubMed
14.
Zurück zum Zitat Hu JC, Gold KF, Pashos CL, Mehta SS, Litwin MS. Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol. 2003;21:401–5.PubMedCrossRef Hu JC, Gold KF, Pashos CL, Mehta SS, Litwin MS. Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol. 2003;21:401–5.PubMedCrossRef
15.
Zurück zum Zitat Gore JL, Saigal CS, Hanley JM, Schonlau M, Litwin MS. Variations in reconstruction after radical cystectomy. Cancer. 2006;107:729–37.PubMedCrossRef Gore JL, Saigal CS, Hanley JM, Schonlau M, Litwin MS. Variations in reconstruction after radical cystectomy. Cancer. 2006;107:729–37.PubMedCrossRef
16.
Zurück zum Zitat Madersbacher S, Hochreiter W, Burkhard F, et al. Radical cystectomy for bladder cancer today—a homogeneous series without neoadjuvant therapy. J Clin Oncol. 2003;21:690–6.PubMedCrossRef Madersbacher S, Hochreiter W, Burkhard F, et al. Radical cystectomy for bladder cancer today—a homogeneous series without neoadjuvant therapy. J Clin Oncol. 2003;21:690–6.PubMedCrossRef
17.
Zurück zum Zitat Hautmann RE, Gschwend JE, de Petriconi RC, Kron M, Volkmer BG. Cystectomy for transitional cell carcinoma of the bladder: results of a surgery only series in the neobladder era. J Urol. 2006;176:486–92.PubMedCrossRef Hautmann RE, Gschwend JE, de Petriconi RC, Kron M, Volkmer BG. Cystectomy for transitional cell carcinoma of the bladder: results of a surgery only series in the neobladder era. J Urol. 2006;176:486–92.PubMedCrossRef
18.
Zurück zum Zitat Novara G, De Marco V, Aragona M, et al. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol. 2009;182:914–21.PubMedCrossRef Novara G, De Marco V, Aragona M, et al. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol. 2009;182:914–21.PubMedCrossRef
19.
Zurück zum Zitat Abdollah F, Budaus L, Sun M, et al. Impact of caseload on total hospital charges: a direct comparison between minimally invasive and open radical prostatectomy—a population based study. J Urol. in press. Abdollah F, Budaus L, Sun M, et al. Impact of caseload on total hospital charges: a direct comparison between minimally invasive and open radical prostatectomy—a population based study. J Urol. in press.
20.
Zurück zum Zitat Birkmeyer NJ, Dimick JB, Share D, et al. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304:435–42.PubMedCrossRef Birkmeyer NJ, Dimick JB, Share D, et al. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304:435–42.PubMedCrossRef
Metadaten
Titel
Surgical Caseload is an Important Determinant of Continent Urinary Diversion Rate at Radical Cystectomy: A Population-Based Study
verfasst von
Firas Abdollah, MD
Maxine Sun, BSc
Jan Schmitges, MD
Rodolphe Thuret, MD
Orchidee Djahangirian
Claudio Jeldres, MD
Zhe Tian, BSc
Shahrokh F. Shariat, MD
Paul Perrotte, MD
Francesco Montorsi, MD
Pierre I. Karakiewicz, MD
Publikationsdatum
01.09.2011
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 9/2011
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1618-2

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