ArticleCanadian Urological Association journal = Journal de l'Association des urologues du Canada2020
Effect of centralization on complex surgical care: A population-based case study of radical cystectomy.
Article in Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Inappropriate use of clinical practices in Canada: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2022Pooled it
- The Financial Argument for Centralization of Care for Esophagectomy.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2026Article
- Complete response: A lens into the future of urology?Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2025Article
- Impact of travel distance on short-term outcomes in patients receiving treatment for urolithiasis A population-based study.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2025Article
- The anesthesia human resources crisis in Canada.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2024Article
- Real-life benchmarking bladder cancer care: A population-based study.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2023Article
- Understanding the Influence of Hospital Volume on Inpatient Outcomes Following Hospitalization for Status Epilepticus.Neurocritical care · 2023Article
- Effect of Centralization on Surgical Outcome of Children Operated for Liver Tumors in Switzerland: A Retrospective Comparative Study.Children (Basel, Switzerland) · 2022Article
- Improving outcomes of radical cystectomy: A call for passive over active regionalization.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2020Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionWe sought to determine whether non-mandated or passive centralization of radical cystectomy (RC) to higher-volume centers leads to enhanced processes of care and outcomes.
methodsThis is a population-based, retrospective, cohort study that used the Ontario Cancer Registry (OCR) to identify all incident patients who underwent RC from 1994-2013. Electronic records of treatment were linked to OCR; pathology records were obtained for all cases and reviewed by a team of trained data abstractors. The primary objective was to describe annual provider RC volumes. Secondary objectives included investigating process and outcome measures.
resultsFor the 5574 patients identified, the mean annual surgeon volume and hospital volume of RC from 1994-2008 was 4.5 (95% confidence interval [CI] 4.4-4.7) and 12.2 (95% CI 11.8-12.5), respectively. From 2009-2013, these volumes significantly increased to 6.8 (95% CI 6.5-7. 1) and 16.4 (95% CI 15.8-16.9). Process variables improved over time, including the use of neoadjuvant chemotherapy. Over the study period, there was a substantial improvement in cancer-specific survival (CSS): hazard ratio (HR) 0.60 (95% CI 0.53-0.67) for 2009-2013. During the most recent era, there was still evidence of a provider volume effect on both process measures and CSS.
conclusionsThere has been recent passive centralization of RC to higher-volume providers in the province of Ontario, with measurable improvements in processes of quality care. Although centralization was also associated with improvement in CSS, in the most recent era, there continues to be low-volume providers with a residual volume-outcome effect.
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Registered trials
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