OBJECTIVE: To assess systematically the quality of evidence for the volume-outcome relationship in uro-oncology, and thus facilitate the formulating of health policy within this speciality, as 'Implementation of Improving Outcome Guidance' has led to centralization of uro-oncology based on published studies that have supported a 'higher volume-better outcome' relationship, but improved awareness of methodological drawbacks in health service research has questioned the strength of this proposed volume-outcome relationship. METHODS: We systematically searched previous relevant reports and extracted all articles from 1980 onwards assessing the volume-outcome relationship for cystectomy, prostatectomy and nephrectomy at the institution and/or surgeon level. Studies were assessed for their methodological quality using a previously validated rating system. Where possible, meta-analytical methods were used to calculate overall differences in outcome measures between low and high volume healthcare providers. RESULTS: In all, 22 studies were included in the final analysis; 19 of these were published in the last 5 years. Only four studies appropriately explored the effect of both the institution and surgeon volume on outcome measures. Mortality and length of stay were the most frequently measured outcomes. The median total quality scores within each of the operation types were 8.5, 9 and 8 for cystectomy, prostatectomy and nephrectomy, respectively (possible maximum score 18). Random-effects modelling showed a higher risk of mortality in low-volume institutions than in higher-volume institutions for both cystectomy and nephrectomy (odds ratio 1.88, 95% confidence interval 1.54-2.29, and 1.28, 1.10-1.49, respectively). CONCLUSION: The methodological quality of volume-outcome research as applied to cystectomy, prostatectomy and nephrectomy is only modest at best. Accepting several limitations, pooled analysis confirms a higher-volume, lower-mortality relationship for cystectomy and nephrectomy. Future research should focus on the development of a quality framework with a validated scoring system for the bench-marking of data to improve validity and facilitate rational policy-making within the speciality of uro-oncology.
OBJECTIVE: To assess systematically the quality of evidence for the volume-outcome relationship in uro-oncology, and thus facilitate the formulating of health policy within this speciality, as 'Implementation of Improving Outcome Guidance' has led to centralization of uro-oncology based on published studies that have supported a 'higher volume-better outcome' relationship, but improved awareness of methodological drawbacks in health service research has questioned the strength of this proposed volume-outcome relationship. METHODS: We systematically searched previous relevant reports and extracted all articles from 1980 onwards assessing the volume-outcome relationship for cystectomy, prostatectomy and nephrectomy at the institution and/or surgeon level. Studies were assessed for their methodological quality using a previously validated rating system. Where possible, meta-analytical methods were used to calculate overall differences in outcome measures between low and high volume healthcare providers. RESULTS: In all, 22 studies were included in the final analysis; 19 of these were published in the last 5 years. Only four studies appropriately explored the effect of both the institution and surgeon volume on outcome measures. Mortality and length of stay were the most frequently measured outcomes. The median total quality scores within each of the operation types were 8.5, 9 and 8 for cystectomy, prostatectomy and nephrectomy, respectively (possible maximum score 18). Random-effects modelling showed a higher risk of mortality in low-volume institutions than in higher-volume institutions for both cystectomy and nephrectomy (odds ratio 1.88, 95% confidence interval 1.54-2.29, and 1.28, 1.10-1.49, respectively). CONCLUSION: The methodological quality of volume-outcome research as applied to cystectomy, prostatectomy and nephrectomy is only modest at best. Accepting several limitations, pooled analysis confirms a higher-volume, lower-mortality relationship for cystectomy and nephrectomy. Future research should focus on the development of a quality framework with a validated scoring system for the bench-marking of data to improve validity and facilitate rational policy-making within the speciality of uro-oncology.
Authors: Quoc-Dien Trinh; Anders Bjartell; Stephen J Freedland; Brent K Hollenbeck; Jim C Hu; Shahrokh F Shariat; Maxine Sun; Andrew J Vickers Journal: Eur Urol Date: 2013-04-19 Impact factor: 20.096
Authors: Gian Maria Busetto; Daniele D'Agostino; Michele Colicchia; Katie Palmer; Walter Artibani; Alessandro Antonelli; Lorenzo Bianchi; Aldo Bocciardi; Eugenio Brunocilla; Marco Carini; Giuseppe Carrieri; Luigi Cormio; Ugo Giovanni Falagario; Ettore De Berardinis; Alessandro Sciarra; Costantino Leonardo; Francesco Del Giudice; Martina Maggi; Ottavio de Cobelli; Matteo Ferro; Gennaro Musi; Amelio Ercolino; Fabrizio Di Maida; Andrea Gallina; Carlo Introini; Ettore Mearini; Giovanni Cochetti; Andrea Minervini; Francesco Montorsi; Riccardo Schiavina; Sergio Serni; Claudio Simeone; Paolo Parma; Armando Serao; Mario Salvatore Mangano; Giorgio Pomara; Pasquale Ditonno; Alchiede Simonato; Daniele Romagnoli; Alessandro Crestani; Angelo Porreca Journal: Front Oncol Date: 2022-05-05 Impact factor: 5.738
Authors: Ray C J Hsu; Theodosia Salika; Jonathan Maw; Georgios Lyratzopoulos; Vincent J Gnanapragasam; James N Armitage Journal: BMJ Open Date: 2017-09-05 Impact factor: 2.692