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Effect of hospital volume on 90-day mortality after radical cystectomy for bladder cancer in Spain

  • Carlos LlorenteEmail author
  • Ana Guijarro
  • Virginia Hernandez
  • Guillermo Fernández-Conejo
  • Elia Perez-Fernandez
  • Stuart Pocock
Original Article

Abstract

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.

Keywords

Radical cystectomy Surgical mortality Perioperative outcomes Bladder cancer 

Abbreviations

RC

Radical cystectomy

Notes

Author contributions

CL: project development, manuscript writing, data collection; AG: data collection, manuscript editing; VH: manuscript editing; GF: manuscript editing; EP: data analysis; SP: data analysis, manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

345_2019_2874_MOESM1_ESM.docx (290 kb)
Supplementary material 1 (DOCX 289 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Carlos Llorente
    • 1
    Email author
  • Ana Guijarro
    • 1
  • Virginia Hernandez
    • 1
  • Guillermo Fernández-Conejo
    • 1
  • Elia Perez-Fernandez
    • 1
  • Stuart Pocock
    • 2
  1. 1.Department of Urology and Research UnitHospital Universitario Fundación AlcorconAlcorcónSpain
  2. 2.Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK

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