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Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population-based study
Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden.
Regional Cancer Centre South, Region Skåne, Lund, Sweden.
Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
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2019 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 124, no 3, p. 449-456Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the association between hospital volume on overall survival (OS), cancer-specific survival (CSS), and quality of care defined as use of extended lymphadenectomy, continent reconstruction, neoadjuvant chemotherapy and treatment delay less than 3 months.

MATERIALS AND METHODS: We used Bladder Cancer Data Base Sweden (BladderBaSe) to study survival and indicators of perioperative quality of care in all 3172 patients who underwent radical cystectomy for primary invasive bladder cancer stage T1-T3 in Sweden 1997-2014. The period-specific mean annual hospital volume (PSMAV) during the 3 years preceding surgery was applied as an exposure and analysed using univariate and multivariate mixed models, adjusting for tumour and nodal stage, age, gender, comorbidity, educational level and neoadjuvant chemotherapy. PSMAV was either categorised in tertiles, dichotomised (at 25 or more cystectomies annually), or used as a continuous variable for every increase of 10 cystectomies annually.

RESULTS: PSMAV in the highest tertile (25 or more cystectomies annually) was associated with improved overall survival (HR 0.87, 95% CI 0.75-1.0), whereas corresponding HR for cancer-specific survival was 0.87 (95% CI 0.73-1.04). With PSMAV as a continuous variable, overall survival was improved for every increase of 10 cystectomies annually (HR 0.95, 95% CI 0.90-0.99). Moreover, higher PSMAV was associated with increased use of extended lymphadenectomy, continent reconstruction and neoadjuvant chemotherapy, but also more frequently with a treatment delay of more than 3 months after diagnosis.

CONCLUSIONS: The current study supports centralisation of radical cystectomy for bladder cancer, but also underpins the need for monitoring treatment delays associated with referral.

Place, publisher, year, edition, pages
Blackwell Publishing, 2019. Vol. 124, no 3, p. 449-456
Keywords [en]
Bladder cancer, hospital volume, quality of care, radical cystectomy, survival
National Category
Cancer and Oncology Urology and Nephrology
Identifiers
URN: urn:nbn:se:oru:diva-73581DOI: 10.1111/bju.14767ISI: 000482452800019PubMedID: 30950568Scopus ID: 2-s2.0-85064609953OAI: oai:DiVA.org:oru-73581DiVA, id: diva2:1302983
Funder
Swedish Cancer Society, CAN 2016/470 CAN 2017/278Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-09-16Bibliographically approved

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Jerlström, Tomas

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