Open AccessImpact of provider volume on operative mortality after radical cystectomy in a publicly funded healthcare system
Author(s) -
Girish S. Kulkarni,
David R. Urbach,
Peter C. Austin,
Neil Fleshner,
Andreas Laupacis
Publication year - 2013
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.477
H-Index - 38
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.361
Subject(s) - cystectomy , medicine , bladder cancer , odds ratio , confidence interval , logistic regression , healthcare cost and utilization project , odds , emergency medicine , health care , cancer , economics , economic growth
We assess the effect of cystectomy provider volumeon 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.