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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

Liedberg, Fredrik LU ; Hagberg, Oskar LU ; Aljabery, Firas ; Gårdmark, Truls ; Hosseini, Abolfazl ; Jahnson, Staffan ; Jancke, Georg LU ; Jerlström, Tomas ; Malmström, Per Uno and Sherif, Amir , et al. (2019) In BJU International 124(3). p.449-456
Abstract

Objective: To investigate the association between hospital volume and overall survival (OS), cancer-specific survival (CSS), and quality of care of patients with bladder cancer who undergo radical cystectomy (RC), defined as the use of extended lymphadenectomy (eLND), continent reconstruction, neoadjuvant chemotherapy (NAC), and treatment delay of <3 months. Patients and Methods: We used the Bladder Cancer Data Base Sweden (BladderBaSe) to study survival and indicators of perioperative quality of care in all 3172 patients who underwent RC for primary invasive bladder cancer stage T1–T3 in Sweden between 1997 and 2014. The period-specific mean annual hospital volume (PSMAV) during the 3 years preceding surgery was applied as an... (More)

Objective: To investigate the association between hospital volume and overall survival (OS), cancer-specific survival (CSS), and quality of care of patients with bladder cancer who undergo radical cystectomy (RC), defined as the use of extended lymphadenectomy (eLND), continent reconstruction, neoadjuvant chemotherapy (NAC), and treatment delay of <3 months. Patients and Methods: We used the Bladder Cancer Data Base Sweden (BladderBaSe) to study survival and indicators of perioperative quality of care in all 3172 patients who underwent RC for primary invasive bladder cancer stage T1–T3 in Sweden between 1997 and 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 NAC. PSMAV was either categorised in tertiles, dichotomised (at ≥25 RCs annually), or used as a continuous variable for every increase of 10 RCs annually. Results: PSMAV in the highest tertile (≥25 RCs annually) was associated with improved OS (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.75–1.0), whereas the corresponding HR for CSS was 0.87 (95% CI 0.73–1.04). With PSMAV as a continuous variable, OS was improved for every increase of 10 RCs annually (HR 0.95, 95% CI 0.90–0.99). Moreover, higher PSMAV was associated with increased use of eLND, continent reconstruction and NAC, but also more frequently with a treatment delay of >3 months after diagnosis. Conclusions: The current study supports centralisation of RC for bladder cancer, but also underpins the need for monitoring treatment delays associated with referral.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
#BladderCancer, #blcsm, hospital volume, quality of care, radical cystectomy, survival
in
BJU International
volume
124
issue
3
pages
449 - 456
publisher
Wiley-Blackwell
external identifiers
  • pmid:30950568
  • scopus:85064609953
ISSN
1464-4096
DOI
10.1111/bju.14767
language
English
LU publication?
yes
id
37ffa502-9374-464e-89eb-3ab80b8c53e4
date added to LUP
2019-05-07 11:03:43
date last changed
2021-04-06 02:33:41
@article{37ffa502-9374-464e-89eb-3ab80b8c53e4,
  abstract     = {<p>Objective: To investigate the association between hospital volume and overall survival (OS), cancer-specific survival (CSS), and quality of care of patients with bladder cancer who undergo radical cystectomy (RC), defined as the use of extended lymphadenectomy (eLND), continent reconstruction, neoadjuvant chemotherapy (NAC), and treatment delay of &lt;3 months. Patients and Methods: We used the Bladder Cancer Data Base Sweden (BladderBaSe) to study survival and indicators of perioperative quality of care in all 3172 patients who underwent RC for primary invasive bladder cancer stage T1–T3 in Sweden between 1997 and 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 NAC. PSMAV was either categorised in tertiles, dichotomised (at ≥25 RCs annually), or used as a continuous variable for every increase of 10 RCs annually. Results: PSMAV in the highest tertile (≥25 RCs annually) was associated with improved OS (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.75–1.0), whereas the corresponding HR for CSS was 0.87 (95% CI 0.73–1.04). With PSMAV as a continuous variable, OS was improved for every increase of 10 RCs annually (HR 0.95, 95% CI 0.90–0.99). Moreover, higher PSMAV was associated with increased use of eLND, continent reconstruction and NAC, but also more frequently with a treatment delay of &gt;3 months after diagnosis. Conclusions: The current study supports centralisation of RC for bladder cancer, but also underpins the need for monitoring treatment delays associated with referral.</p>},
  author       = {Liedberg, Fredrik and Hagberg, Oskar and Aljabery, Firas and Gårdmark, Truls and Hosseini, Abolfazl and Jahnson, Staffan and Jancke, Georg and Jerlström, Tomas and Malmström, Per Uno and Sherif, Amir and Ströck, Viveka and Häggström, Christel and Holmberg, Lars},
  issn         = {1464-4096},
  language     = {eng},
  month        = {04},
  number       = {3},
  pages        = {449--456},
  publisher    = {Wiley-Blackwell},
  series       = {BJU International},
  title        = {Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care : a nationwide population-based study},
  url          = {http://dx.doi.org/10.1111/bju.14767},
  doi          = {10.1111/bju.14767},
  volume       = {124},
  year         = {2019},
}