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Quality of Care Indicators for Radical Cystectomy

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Bladder Cancer

Part of the book series: Current Clinical Urology ((CCU))

Abstract

Radical cystectomy is the gold standard treatment for invasive bladder cancer, and requires high standards for both surgical skill and ancillary support to achieve consistently good outcomes. As is the case elsewhere in the health care system, increasing attention has been paid in recent years to the quality of care delivered before, during, and after surgery. Defining high-quality care in the context of cystectomy, however, is far from straightforward. Multiple outcomes are relevant – perioperative morbidity and mortality, long-term oncologic outcomes, and urinary and sexual health-related quality of life – as there exists as yet no consensus on the best way to measure these outcomes and appropriately risk-adjust them based on patient case mix.

The process of identification and validation of structural aspects of care and processes of care which are likely to predict good outcomes is in an early stage for cystectomy. Several candidate measures have been examined, and each is controversial to some extent with respect to its relevance to cystectomy outcomes. The time from diagnosis to cystectomy, adequacy of lymphadenectomy, and availability of orthotopic diversion are three process measures which are good candidate indicators of quality care. Surgical volume, both surgeon- and hospital-specific, has received a great deal of attention in the media, but results of the studies to date must be interpreted cautiously, and the implications of policies implicitly or explicitly driving regionalization of cystectomy care should be carefully considered. It is critical that clinicians specializing in the care of bladder cancer, rather than regulators or insurers, continue to direct progress in forging consensus on approaches to measurement and reporting of quality outcomes for radical is in an early stage for cystectomy.

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Authors and Affiliations

  1. Department of Urology, University of California San Francisco, San Francisco, CA, USA

    Matthew R. Cooperberg & Badrinath R. Konety

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  1. Matthew R. Cooperberg
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  2. Badrinath R. Konety
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Correspondence to Badrinath R. Konety .

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Editors and Affiliations

  1. Dept. Urology, University of Michigan Health System, E. Medical Center Dr. 1500 , Ann Arbor, 48109-0252, U.S.A.

    Cheryl T. Lee

  2. Dept. Urology, University of Michigan Health System, E. Medical Center Dr. 1500 , Ann Arbor, 48109-0252, U.S.A.

    David P. Wood

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Cooperberg, M.R., Konety, B.R. (2009). Quality of Care Indicators for Radical Cystectomy. In: Lee, C., Wood, D. (eds) Bladder Cancer. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-59745-417-9_18

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  • DOI: https://doi.org/10.1007/978-1-59745-417-9_18

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