ArticleBMJ (Clinical research ed.)2010
The volume-mortality relation for radical cystectomy in England: retrospective analysis of hospital episode statistics.
Article in BMJ (Clinical research ed.), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 3 of them syntheses that pooled it.
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Who cites it
19 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Impact of Centralizing Care for Genitourinary Malignancies to High-volume Providers: A Systematic Review.European urology oncology · 2019Pooled it
- [Morbidity, mortality, and overall survival after radical cystectomy: comparison of single-center results with the literature and a nomogram].Der Urologe. Ausg. A · 2014Pooled it
- Systematic review of discharge coding accuracy.Journal of public health (Oxford, England) · 2012Pooled it
- Survival Outcomes of Open Versus Robot-Assisted Radical Cystectomy: A Large-Scale Multicenter Propensity Score Matched Study.Journal of clinical medicine · 2026Article
- The effect of hospital caseload on perioperative mortality, morbidity and costs in bladder cancer patients undergoing radical cystectomy: results of the German nationwide inpatient data.World journal of urology · 2024Article
- Optimizing surgical outcomes in bladder cancer patients undergoing radical cystectomy.Frontiers in surgery · 2022Review
- Development of Incidence and Surgical Treatment of Penile Cancer in Germany from 2006 to 2016: Potential Implications for Future Management.Annals of surgical oncology · 2021Article
- Systematic review of the association between socioeconomic status and bladder cancer survival with hospital type, comorbidities, and treatment delay as mediators.BJUI compass · 2021Review
- Centralization tendencies of retroperitoneal lymph node dissection for testicular cancer in Germany? A total population-based analysis from 2006 to 2015.World journal of urology · 2020Article
- Association between hospital surgical volume and perioperative outcomes of fertility-sparing trachelectomy for cervical cancer: A national study in the United States.Gynecologic oncology · 2020Observational
- SIU-ICUD consultation on bladder cancer: treatment of muscle-invasive bladder cancer.World journal of urology · 2019Review
- High hospital and surgeon volume and its impact on overall survival after radical cystectomy among patients with bladder cancer in Quebec.World journal of urology · 2015Article
- Minimum volume standards in German hospitals: do they get along with procedure centralization? A retrospective longitudinal data analysis.BMC health services research · 2015Article
- Is a clear benefit in survival enough to modify patient access to the surgery service? A retrospective analysis in a cohort of gastric cancer patients.Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2015Article
- Postoperative mortality and complications after radical cystectomy for bladder cancer in Quebec: A population-based analysis during the years 2000-2009.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2014Article
- Life after the cancer strategy: analysis of surgical workload in the general hospital setting.Irish journal of medical science · 2013Article
- Impact of academic affiliation on radical cystectomy outcomes in North America: A population-based study.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2012Article
- Comparing baseline symptom severity and demographics over two time periods in an outpatient palliative radiotherapy clinic.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2012Article
- Proactive approach to treat high-grade lamina-invasive bladder cancer.Indian journal of urology : IJU : journal of the Urological Society of India · 2011Article
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5 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectivesTo investigate the relation between volume and mortality after adjustment for case mix for radical cystectomy in the English healthcare setting using improved statistical methodology, taking into account the institutional and surgeon volume effects and institutional structural and process of care factors.
designRetrospective analysis of hospital episode statistics using multilevel modelling.
settingEnglish hospitals carrying out radical cystectomy in the seven financial years 2000/1 to 2006/7.
participantsPatients with a primary diagnosis of cancer undergoing an inpatient elective cystectomy.
main outcome measureMortality within 30 days of cystectomy.
resultsCompared with low volume institutions, medium volume ones had a significantly higher odds of in-hospital and total mortality: odds ratio 1.72 (95% confidence interval 1.00 to 2.98, P=0.05) and 1.82 (1.08 to 3.06, P=0.02). This was only seen in the final model, which included adjustment for structural and processes of care factors. The surgeon volume-mortality relation showed weak evidence of reduced odds of in-hospital mortality (by 35%) for the high volume surgeons, although this did not reach statistical significance at the 5% level.
conclusionsThe relation between case volume and mortality after radical cystectomy for bladder cancer became evident only after adjustment for structural and process of care factors, including staffing levels of nurses and junior doctors, in addition to case mix. At least for this relatively uncommon procedure, adjusting for these confounders when examining the volume-outcome relation is critical before considering centralisation of care to a few specialist institutions. Outcomes other than mortality, such as functional morbidity and disease recurrence may ultimately influence towards centralising care.
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