Impact of surgeon volume on the morbidity and costs of radical cystectomy in the USA: a contemporary population-based analysis

ÌÇÐÄ´«Ã½

Abstract

To evaluate the relationship between surgeon volume of radical cystectomy (RC) and postoperative morbidity as well as the economic burden of bladder cancer in the United States.We captured all patients who underwent a RC (ICD-9 code 57.71) from 2003 to 2010, using a nationwide hospital discharge database. Patient, hospital, and surgical characteristics were evaluated. Annual volume of RC for surgeons was divided into quintiles. Multivariable regression models were developed adjusting for clustering and survey weighting to evaluate the outcomes including 90-day major complications (Clavien 3-5) and direct patient costs. We adjusted for clustering and weighting to achieve a nationally representative analysis.The weighted cohort included 49,792 RC patients with an overall 90-day major complication rate of 16.2%. Compared to surgeons performing one RC annually, surgeons performing =7 RC each year had a 45% decreased odds of major complications (OR: 0.55, p<0.001) and a reduction in costs by $1690 (p=0.02). Results were consistent when we analyzed surgeon volume as a continuous variable and when we examined the highest volume surgeons (=28 cases annually), which found a marked decreased odds of major complications compared to the lowest volume surgeons (OR: 0.45, 95% CI: 0.31-0.67, p<0.0001). Compared to patients who did not have any complications, those who suffered a major complication had significantly higher 90-day median direct hospital costs ($43965 vs. $24341, p<0.0001).We demonstrate an inverse relationship between surgeon volume and the development of postoperative 90-day major complication rates as well as direct hospital costs. Centralization of RC to higher volume surgeons may reduce the development of postoperative major complications thereby decreasing the burden of bladder cancer on the health care system.

View details for

View details for

View details for