Girish S Kulkarni1, David R Urbach2, Peter C Austin3, Neil E Fleshner4, Andreas Laupacis5. 1. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; ; Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON; ; Institute for Clinical Evaluative Sciences, Toronto, ON. 2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; ; Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, ON; ; Institute for Clinical Evaluative Sciences, Toronto, ON. 3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; ; Institute for Clinical Evaluative Sciences, Toronto, ON. 4. Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON; 5. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; ; Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON; ; Institute for Clinical Evaluative Sciences, Toronto, ON.
Abstract
INTRODUCTION: We assess the effect of cystectomy provider volume on postoperative mortality in a publicly funded healthcare system. Hospital and surgeon (provider) volume have been shown to be associated with clinically important outcomes for many types of surgery. Volume-outcome studies in patients undergoing radical cystectomy for bladder cancer have primarily originated from privately funded healthcare systems. METHODS: We identified patients undergoing cystectomy in Ontario, Canada, between 1992 and 2004 using administrative databases. The effect of provider volume on postoperative mortality was assessed with multilevel (hierarchical or random effects) logistic regression models, adjusted for patient characteristics. Separate models were fit to examine the effect of surgeon volume and the effect of hospital volume. RESULTS: Of the 3296 cystectomy patients identified, 126 (3.8%) experienced a postoperative death. Neither hospital volume (odds ratio [per 1 unit increase in volume] 0.98, 95% confidence interval [CI] 0.95-1.00; p = 0.074) nor surgeon volume (odds ratio 0.96, 95% CI 0.90-1.02; p = 0.143) were statistically significantly associated with postoperative cystectomy mortality. CONCLUSIONS: In Ontario's publicly funded healthcare system, provider volume was not significantly associated with postoperative mortality.
INTRODUCTION: We assess the effect of cystectomy provider volume on postoperative mortality in a publicly funded healthcare system. Hospital and surgeon (provider) volume have been shown to be associated with clinically important outcomes for many types of surgery. Volume-outcome studies in patients undergoing radical cystectomy for bladder cancer have primarily originated from privately funded healthcare systems. METHODS: We identified patients undergoing cystectomy in Ontario, Canada, between 1992 and 2004 using administrative databases. The effect of provider volume on postoperative mortality was assessed with multilevel (hierarchical or random effects) logistic regression models, adjusted for patient characteristics. Separate models were fit to examine the effect of surgeon volume and the effect of hospital volume. RESULTS: Of the 3296 cystectomy patients identified, 126 (3.8%) experienced a postoperative death. Neither hospital volume (odds ratio [per 1 unit increase in volume] 0.98, 95% confidence interval [CI] 0.95-1.00; p = 0.074) nor surgeon volume (odds ratio 0.96, 95% CI 0.90-1.02; p = 0.143) were statistically significantly associated with postoperative cystectomy mortality. CONCLUSIONS: In Ontario's publicly funded healthcare system, provider volume was not significantly associated with postoperative mortality.
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: Girish S Kulkarni; Andreas Laupacis; David R Urbach; Neil E Fleshner; Peter C Austin Journal: J Clin Epidemiol Date: 2008-11-14 Impact factor: 6.437
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