Published in:
01-05-2020 | Cystectomy | Original Article
Effect of hospital volume on 90-day mortality after radical cystectomy for bladder cancer in Spain
Published in: World Journal of Urology | Issue 5/2020
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Objective
To investigate 90-day mortality rate of RC for bladder cancer in a nationwide population-based study.
Design, setting, and participants
We used mandatory hospital discharge forms of all patients submitted to RC due to bladder cancer in Spain during 2011–2015 (n = 12,154 in 196 hospitals). At present, a centralization policy for RC has not been issued by the health authorities.
Outcome measurements and statistical analysis
We calculated in-hospital, 30-, 60- and 90-day mortality. Average annual RC volume was used as a continuous variable (log-transformed) and also grouped into deciles to identify any potential non-linear relationships. Logistic regression model with mixed effect was performed adjusting for year of surgery, comorbidity, surgical approach, type of admission, age, sex, and hospital size.
Results and limitation
Overall 90-day mortality rate was 6.5%. Lowest mortality rates (3.3% at 90 days) are achieved in hospitals doing more than 38 cases per year. The 90-day adjusted mortality rate is associated with annual average RC volume with a 20.6% decrease per 10 extra RCs/year (95% CI 12.3–28.1% p < 0.001). High Charlson comorbidity index, advanced age, and open surgical approach were the clinical variables associated with higher mortality.
Conclusions
Our study identifies an inverse association between 90-day mortality and hospital volume. High-volume hospitals achieve lower mortality rate within 90 days.