BACKGROUND: The reorganisation of cancer services in England will result in the creation of specialist high volume cancer surgery centres. Studies have suggested a relationship between increasing surgical volume and improved outcomes in urological pelvic cancer surgery, although to date, they have pre-defined the definition of "high" and "low" volume surgeons. AIM: To derive the minimum caseload a surgeon requires to achieve optimum outcomes and to examine the effect of the operating centre size upon individual surgeon's outcomes. METHODS: All cystectomies performed for bladder cancer in England over 5 years were analysed from Hospital Episode Statistics (HES) data. Statistical analysis was undertaken to describe the relationship between each surgeon's annual case volume and two OUTCOME MEASURES: in-hospital mortality rate, and hospital stay. The surgeon's outcomes were then analysed with respect to the overall level of activity in their operating centre. RESULTS: A total of 6308 cystectomies were performed; the mean number of surgeons performing them annually was 327 with an overall mortality rate of 5.53%. A significant inverse correlation (-0.968, p<0.01) was found between case volume and mortality rate. Applying 95% confidence interval estimation, the minimum caseload required to achieve the lowest mortality rate was eight procedures per year. Increasing caseload beyond eight operations per year did not produce a significant reduction in mortality rate. CONCLUSION: Analysis of HES data confirms an inverse relationship between surgeon's caseload and mortality for radical cystectomy. A caseload of eight operations per year is associated with the lowest mortality rate.
BACKGROUND: The reorganisation of cancer services in England will result in the creation of specialist high volume cancer surgery centres. Studies have suggested a relationship between increasing surgical volume and improved outcomes in urological pelvic cancer surgery, although to date, they have pre-defined the definition of "high" and "low" volume surgeons. AIM: To derive the minimum caseload a surgeon requires to achieve optimum outcomes and to examine the effect of the operating centre size upon individual surgeon's outcomes. METHODS: All cystectomies performed for bladder cancer in England over 5 years were analysed from Hospital Episode Statistics (HES) data. Statistical analysis was undertaken to describe the relationship between each surgeon's annual case volume and two OUTCOME MEASURES: in-hospital mortality rate, and hospital stay. The surgeon's outcomes were then analysed with respect to the overall level of activity in their operating centre. RESULTS: A total of 6308 cystectomies were performed; the mean number of surgeons performing them annually was 327 with an overall mortality rate of 5.53%. A significant inverse correlation (-0.968, p<0.01) was found between case volume and mortality rate. Applying 95% confidence interval estimation, the minimum caseload required to achieve the lowest mortality rate was eight procedures per year. Increasing caseload beyond eight operations per year did not produce a significant reduction in mortality rate. CONCLUSION: Analysis of HES data confirms an inverse relationship between surgeon's caseload and mortality for radical cystectomy. A caseload of eight operations per year is associated with the lowest mortality rate.
Authors: John D Birkmeyer; Therese A Stukel; Andrea E Siewers; Philip P Goodney; David E Wennberg; F Lee Lucas Journal: N Engl J Med Date: 2003-11-27 Impact factor: 91.245
Authors: Nathan Lawrentschuk; Andrew Evans; John Srigley; Joseph L Chin; Bish Bora; Amber Hunter; Robin McLeod; Neil E Fleshner Journal: Can Urol Assoc J Date: 2011-06 Impact factor: 1.862
Authors: Girish S Kulkarni; David R Urbach; Peter C Austin; Neil E Fleshner; Andreas Laupacis Journal: Can Urol Assoc J Date: 2013 Nov-Dec Impact factor: 1.862
Authors: Ahmet Murat Aydin; Richard R Reich; Biwei Cao; Salim K Cheriyan; Ali Hajiran; Logan Zemp; Alice Yu; Michael A Poch; Wade J Sexton; Roger Li; Scott M Gilbert Journal: Urol Oncol Date: 2021-10-08 Impact factor: 3.498
Authors: Jonathan L Silberstein; Stephen A Poon; Alexandra C Maschino; William T Lowrance; Tullika Garg; Harry W Herr; S Machele Donat; Guido Dalbagni; Bernard H Bochner; Jaspreet S Sandhu Journal: J Urol Date: 2012-09-23 Impact factor: 7.450