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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

Artikel i vetenskaplig tidskrift
Författare F. Liedberg
O. Hagberg
F. Aljabery
T. Gardmark
A. Hosseini
S. Jahnson
G. Jancke
T. Jerlstrom
P. U. Malmstrom
A. Sherif
Viveka Ströck
C. Haggstrom
L. Holmberg
Publicerad i Bju International
Volym 124
Nummer/häfte 3
Sidor 449-456
ISSN 1464-4096
Publiceringsår 2019
Publicerad vid Institutionen för kliniska vetenskaper
Sidor 449-456
Språk en
Länkar dx.doi.org/10.1111/bju.14767
Ämnesord hospital volume, radical cystectomy, survival, quality of care, #blcsm, #BladderCancer, bladder-cancer, surgeon volume, operative mortality, impact, survival, morbidity, Urology & Nephrology
Ämneskategorier Cancer och onkologi, Urologi och njurmedicin

Sammanfattning

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 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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