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



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.


Our study identifies an inverse association between 90-day mortality and hospital volume. High-volume hospitals achieve lower mortality rate within 90 days.

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Radical cystectomy


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Author information




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.

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Correspondence to Carlos Llorente.

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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.

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Llorente, C., Guijarro, A., Hernandez, V. et al. Effect of hospital volume on 90-day mortality after radical cystectomy for bladder cancer in Spain. World J Urol 38, 1221–1228 (2020). https://doi.org/10.1007/s00345-019-02874-9

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  • Radical cystectomy
  • Surgical mortality
  • Perioperative outcomes
  • Bladder cancer