Trends In Regionalization Of Inpatient Care For Urological Malignancies, 1988 To 2002

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Clinical Trials / Drug Trials
Article Date: 17 Nov 2007 - 0:00 PDT

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UroToday.com- Patients undergoing care at centers with higher surgical volumes debatably have superior outcomes. Whether the referral of these patients to high volume hospitals (HVHs) or regionalization, as it is called, is occurring in the US for patients with urologic cancers was evaluated by Dr. Cooperberg and is reported in the November issue of the Journal of Urology.

The authors examined the Nationwide Inpatient Sample dataset of the Health Care Utilization Project between 1998 and 2002. This is a 20% stratified sample of all hospital admissions in the US and included a total of 1,000 hospitals in 35 states. Patient records for renal, bladder, and prostate cancer were abstracted and further separated into surgical and non-surgical admissions. Hospitals were ranked into high, moderate, or low volume for each year.

A total of 26,770 patients were admitted to 1,764 hospitals for a diagnosis of bladder cancer and underwent radical cystectomy. In addition, 134,713 were admitted for bladder cancer without undergoing radical cystectomy at a total of 2,645 hospitals. The relative increases in HVH discharges over the 15-year time frame were considered modest at 67% to 70% of surgical discharges and 70 to 72% of non-surgical discharges.

A total of 64,857 patients underwent nephrectomy at a total of 2,182 hospitals and 21,415 were managed without surgery at a total of 2,288 hospitals. The shift in HVH discharges over the 15 years was 67 to 73% for surgical and 63 to 68% for non-surgical.

Radical prostatectomy was performed in 178,210 men at 2,065 hospitals and 146,311 were treated non-operatively at 2,775 hospitals. Interestingly, the number of radical prostatectomy surgical HVH discharges remained constant at 76% and the percent of non-surgical cases discharged from HVHs decreased slightly.

A corresponding decrease in surgical and non-surgical discharges from low and moderate volume hospitals for bladder and renal cancers was noted. For prostate cancer, surgical and non-surgical admissions decreased significantly at HVHs with a corresponding increase at lower volume hospitals. A relative increase in surgical discharges from HVHs was 4.5% for bladder cancer and 8.9% for renal cancer, but no increase for prostate cancer. Dr. David Penson in an accompanying editorial suggests that we need to get under the hood" of the volumes-outcomes relationship and determine the variables done well at HVHs and teach these to low volume hospitals.

Cooperberg MR, Modak S, Konety BR

J Urol. 178(5): 2103-2105, November 2007
doi:10.1016/j.juro.2007.07.040

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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