R R de Vries1, O Visser, J A Nieuwenhuijzen, S Horenblas. 1. Department of Urology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Abstract
PURPOSE: To evaluate the effect of volume of cystectomies in the Greater Amsterdam region on postoperative outcomes. METHODS: All primary bladder tumours diagnosed between 1989 and 2003 were selected from the Amsterdam Cancer Registry, a population-based cancer registry (population 3.0 million). For all patients who underwent cystectomy during 1989-2003 at 20 participating hospitals, medical records were reviewed for information on postoperative mortality, locoregional recurrences and relative risk of death. To assess the effect of volume, outcomes at an oncology centre and low-volume hospitals were compared. RESULTS: During 1989-2003 a total of 1,185 cystectomies were performed in 20 hospitals of the Greater Amsterdam region. Postoperative mortality was 3.2%. During 1989-1997, 8% of cystectomies were performed at the oncology centre, increasing to 30% in 1998-2003. Although postoperative mortality at this centre decreased from 4.0% in 1989-1997 to 1.1% in 1998-2003, the latter percentage was not statistically significantly different from the other hospitals during 1998-2003 (OR 0.3; P = 0.09). No statistically significant difference in locoregional recurrence rate and in the relative risk of death was observed between the oncology centre and all other hospitals combined. CONCLUSIONS: We observed a lower postoperative mortality rate in the oncology centre compared to the low-volume hospitals; however, this difference did not reach statistical significance. We could neither prove a statistically significant relation between hospital volume, local recurrence rate and survival after cystectomy. To answer the question if centralisation of cystectomies is beneficial more procedures have to be compared.
PURPOSE: To evaluate the effect of volume of cystectomies in the Greater Amsterdam region on postoperative outcomes. METHODS: All primary bladder tumours diagnosed between 1989 and 2003 were selected from the Amsterdam Cancer Registry, a population-based cancer registry (population 3.0 million). For all patients who underwent cystectomy during 1989-2003 at 20 participating hospitals, medical records were reviewed for information on postoperative mortality, locoregional recurrences and relative risk of death. To assess the effect of volume, outcomes at an oncology centre and low-volume hospitals were compared. RESULTS: During 1989-2003 a total of 1,185 cystectomies were performed in 20 hospitals of the Greater Amsterdam region. Postoperative mortality was 3.2%. During 1989-1997, 8% of cystectomies were performed at the oncology centre, increasing to 30% in 1998-2003. Although postoperative mortality at this centre decreased from 4.0% in 1989-1997 to 1.1% in 1998-2003, the latter percentage was not statistically significantly different from the other hospitals during 1998-2003 (OR 0.3; P = 0.09). No statistically significant difference in locoregional recurrence rate and in the relative risk of death was observed between the oncology centre and all other hospitals combined. CONCLUSIONS: We observed a lower postoperative mortality rate in the oncology centre compared to the low-volume hospitals; however, this difference did not reach statistical significance. We could neither prove a statistically significant relation between hospital volume, local recurrence rate and survival after cystectomy. To answer the question if centralisation of cystectomies is beneficial more procedures have to be compared.
Authors: John D Birkmeyer; Andrea E Siewers; Emily V A Finlayson; Therese A Stukel; F Lee Lucas; Ida Batista; H Gilbert Welch; David E Wennberg Journal: N Engl J Med Date: 2002-04-11 Impact factor: 91.245
Authors: N Tjarda van Heek; Koert F D Kuhlmann; Rob J Scholten; Steve M M de Castro; Olivier R C Busch; Thomas M van Gulik; Huug Obertop; Dirk J Gouma Journal: Ann Surg Date: 2005-12 Impact factor: 12.969
Authors: Adrian Fairey; Michael Chetner; James Metcalfe; Ronald Moore; Gerald Todd; Keith Rourke; Don Voaklander; Eric Estey Journal: J Urol Date: 2008-05-15 Impact factor: 7.450
Authors: Marcus L Quek; John P Stein; Peter E Clark; Siamak Daneshmand; Gus Miranda; Jie Cai; Susan Groshen; Richard J Cote; Gary Lieskovsky; David I Quinn; Donald G Skinner Journal: J Urol Date: 2004-02 Impact factor: 7.450
Authors: Marcus L Quek; John P Stein; Siamak Daneshmand; Gus Miranda; Duraiyah Thangathurai; Peter Roffey; Eila C Skinner; Gary Lieskovsky; Donald G Skinner Journal: J Urol Date: 2006-03 Impact factor: 7.450
Authors: Christian Verhoef; Rens van de Weyer; Michael Schaapveld; Esther Bastiaannet; John Th M Plukker Journal: Ann Surg Oncol Date: 2007-02-09 Impact factor: 5.344
Authors: Paul Sargos; Brian C Baumann; Libni J Eapen; Amit Bahl; Vedang Murthy; Guilhem Roubaud; Mathieu Orré; Jason A Efstathiou; Shahrokh Shariat; Stephane Larré; Pierre Richaud; John P Christodouleas Journal: Transl Androl Urol Date: 2016-10
Authors: Sophia Liff Maibom; Ulla Nordström Joensen; Alicia Martin Poulsen; Henrik Kehlet; Klaus Brasso; Martin Andreas Røder Journal: BMJ Open Date: 2021-04-14 Impact factor: 2.692
Authors: Beth Russell; Christel Häggström; Lars Holmberg; Fredrik Liedberg; Truls Gårdmark; Richard T Bryan; Pardeep Kumar; Mieke Van Hemelrijck Journal: BJUI Compass Date: 2021-01-07
Authors: Melvin J Kilsdonk; Sabine Siesling; Boukje A C van Dijk; Michel W Wouters; Wim H van Harten Journal: PLoS One Date: 2018-04-12 Impact factor: 3.240