Impact of hospital volume on perioperative outcomes and costs of radical Cystectomy

Analysis of the Maryland Health Services Cost Review Commission database

Research output: Contribution to journalArticle

Abstract

Introduction: The objective of this study was to evaluate the impact of hospital case volume on perioperative outcomes and costs of radical cystectomy (RC) after controlling for differences in patient case mix. Materials and methods: The Maryland Health Services Cost Review Commission database was queried for patients who underwent an open RC between 2000 and 2011. Patients were divided into tertiles based on hospital case volume. Groups were compared for differences in length of intensive care unit (ICU) stay, length of total hospital stay, rate of in-hospital deaths and procedure-related costs. Results: In total, 1620 patients underwent a RC during the study period. Of these patients, 457 (28.2%) underwent surgery at 37 low volume centers, 465 (28.7%) at six mid volume centers and 698 (43.1%) at a single high volume center. The mean case volume of each group was 1.1, 7.0 and 63.5 RC/center/year, respectively. After controlling for marked differences in patient case mix, having surgery at the single high-volume center was independently associated with a decrease in length of ICU stay (coefficient = -0.41 days, 95% CI -0.78-0.05, p = 0.03), in-hospital mortality (OR 0.18, 95% CI 0.04-0.80, p = 0.02) and total medical costs (coefficient = -2.91k USD, 95% CI -4.15-1.67, p <0.001). Decreased total costs were driven by reductions in charges associated with the operating room, drugs, radiology tests, labs, supplies and physical/occupational therapy (all p <0.001). Conclusions: Undergoing RC at a high volume medical center was associated with improved outcomes and reduced costs. These data support the centralization of RC to high volume centers.

Original languageEnglish (US)
Pages (from-to)7102-7107
Number of pages6
JournalThe Canadian journal of urology
Volume21
Issue number1
StatePublished - 2014

Fingerprint

Cystectomy
Health Care Costs
Health Services
Databases
Costs and Cost Analysis
Diagnosis-Related Groups
Intensive Care Units
Length of Stay
Occupational Therapy
Operating Rooms
Hospital Mortality
Radiology
Pharmaceutical Preparations

Keywords

  • Bladder cancer
  • Cost analysis
  • Outcomes
  • Radical cystectomy
  • Surgical volume

ASJC Scopus subject areas

  • Urology

Cite this

@article{55522ae054d84e5c80498cc826b16b4e,
title = "Impact of hospital volume on perioperative outcomes and costs of radical Cystectomy: Analysis of the Maryland Health Services Cost Review Commission database",
abstract = "Introduction: The objective of this study was to evaluate the impact of hospital case volume on perioperative outcomes and costs of radical cystectomy (RC) after controlling for differences in patient case mix. Materials and methods: The Maryland Health Services Cost Review Commission database was queried for patients who underwent an open RC between 2000 and 2011. Patients were divided into tertiles based on hospital case volume. Groups were compared for differences in length of intensive care unit (ICU) stay, length of total hospital stay, rate of in-hospital deaths and procedure-related costs. Results: In total, 1620 patients underwent a RC during the study period. Of these patients, 457 (28.2{\%}) underwent surgery at 37 low volume centers, 465 (28.7{\%}) at six mid volume centers and 698 (43.1{\%}) at a single high volume center. The mean case volume of each group was 1.1, 7.0 and 63.5 RC/center/year, respectively. After controlling for marked differences in patient case mix, having surgery at the single high-volume center was independently associated with a decrease in length of ICU stay (coefficient = -0.41 days, 95{\%} CI -0.78-0.05, p = 0.03), in-hospital mortality (OR 0.18, 95{\%} CI 0.04-0.80, p = 0.02) and total medical costs (coefficient = -2.91k USD, 95{\%} CI -4.15-1.67, p <0.001). Decreased total costs were driven by reductions in charges associated with the operating room, drugs, radiology tests, labs, supplies and physical/occupational therapy (all p <0.001). Conclusions: Undergoing RC at a high volume medical center was associated with improved outcomes and reduced costs. These data support the centralization of RC to high volume centers.",
keywords = "Bladder cancer, Cost analysis, Outcomes, Radical cystectomy, Surgical volume",
author = "Michael Gorin and Max Kates and Mullins, {Jeffrey K.} and Pierorazio, {Phillip Martin} and Brian Matlaga and Schoenberg, {Mark P.} and Trinity Bivalacqua",
year = "2014",
language = "English (US)",
volume = "21",
pages = "7102--7107",
journal = "Canadian Journal of Urology",
issn = "1195-9479",
publisher = "Canadian Journal of Urology",
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TY - JOUR

T1 - Impact of hospital volume on perioperative outcomes and costs of radical Cystectomy

T2 - Analysis of the Maryland Health Services Cost Review Commission database

AU - Gorin, Michael

AU - Kates, Max

AU - Mullins, Jeffrey K.

AU - Pierorazio, Phillip Martin

AU - Matlaga, Brian

AU - Schoenberg, Mark P.

AU - Bivalacqua, Trinity

PY - 2014

Y1 - 2014

N2 - Introduction: The objective of this study was to evaluate the impact of hospital case volume on perioperative outcomes and costs of radical cystectomy (RC) after controlling for differences in patient case mix. Materials and methods: The Maryland Health Services Cost Review Commission database was queried for patients who underwent an open RC between 2000 and 2011. Patients were divided into tertiles based on hospital case volume. Groups were compared for differences in length of intensive care unit (ICU) stay, length of total hospital stay, rate of in-hospital deaths and procedure-related costs. Results: In total, 1620 patients underwent a RC during the study period. Of these patients, 457 (28.2%) underwent surgery at 37 low volume centers, 465 (28.7%) at six mid volume centers and 698 (43.1%) at a single high volume center. The mean case volume of each group was 1.1, 7.0 and 63.5 RC/center/year, respectively. After controlling for marked differences in patient case mix, having surgery at the single high-volume center was independently associated with a decrease in length of ICU stay (coefficient = -0.41 days, 95% CI -0.78-0.05, p = 0.03), in-hospital mortality (OR 0.18, 95% CI 0.04-0.80, p = 0.02) and total medical costs (coefficient = -2.91k USD, 95% CI -4.15-1.67, p <0.001). Decreased total costs were driven by reductions in charges associated with the operating room, drugs, radiology tests, labs, supplies and physical/occupational therapy (all p <0.001). Conclusions: Undergoing RC at a high volume medical center was associated with improved outcomes and reduced costs. These data support the centralization of RC to high volume centers.

AB - Introduction: The objective of this study was to evaluate the impact of hospital case volume on perioperative outcomes and costs of radical cystectomy (RC) after controlling for differences in patient case mix. Materials and methods: The Maryland Health Services Cost Review Commission database was queried for patients who underwent an open RC between 2000 and 2011. Patients were divided into tertiles based on hospital case volume. Groups were compared for differences in length of intensive care unit (ICU) stay, length of total hospital stay, rate of in-hospital deaths and procedure-related costs. Results: In total, 1620 patients underwent a RC during the study period. Of these patients, 457 (28.2%) underwent surgery at 37 low volume centers, 465 (28.7%) at six mid volume centers and 698 (43.1%) at a single high volume center. The mean case volume of each group was 1.1, 7.0 and 63.5 RC/center/year, respectively. After controlling for marked differences in patient case mix, having surgery at the single high-volume center was independently associated with a decrease in length of ICU stay (coefficient = -0.41 days, 95% CI -0.78-0.05, p = 0.03), in-hospital mortality (OR 0.18, 95% CI 0.04-0.80, p = 0.02) and total medical costs (coefficient = -2.91k USD, 95% CI -4.15-1.67, p <0.001). Decreased total costs were driven by reductions in charges associated with the operating room, drugs, radiology tests, labs, supplies and physical/occupational therapy (all p <0.001). Conclusions: Undergoing RC at a high volume medical center was associated with improved outcomes and reduced costs. These data support the centralization of RC to high volume centers.

KW - Bladder cancer

KW - Cost analysis

KW - Outcomes

KW - Radical cystectomy

KW - Surgical volume

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VL - 21

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JO - Canadian Journal of Urology

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