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. 2024 Jan 10;42(1):19.
doi: 10.1007/s00345-023-04742-z.

The effect of hospital caseload on perioperative mortality, morbidity and costs in bladder cancer patients undergoing radical cystectomy: results of the German nationwide inpatient data

Nikolaos Pyrgidis  1 , Yannic Volz  2 , Benedikt Ebner  2 , Philipp M Kazmierczak  3 , Benazir Enzinger  2 , Julian Hermans  2 , Alexander Buchner  2 , Christian Stief  2 , Gerald Bastian Schulz  2
Affiliations

The effect of hospital caseload on perioperative mortality, morbidity and costs in bladder cancer patients undergoing radical cystectomy: results of the German nationwide inpatient data

Nikolaos Pyrgidis et al. World J Urol. .

Abstract

Objectives: To determine a data-based optimal annual radical cystectomy (RC) hospital volume threshold and evaluate its clinical significance regarding perioperative mortality, complications, length of hospital stay, and hospital revenues.

Material and methods: We used the German Nationwide inpatient Data, provided by the Research Data Center of the Federal Bureau of Statistics (2005-2020). 95,841 patients undergoing RC were included. Based on ROC analyses, the optimal RC threshold to reduce mortality, ileus, sepsis, transfusion, hospital stay, and costs is 54, 50, 44, 44, 71 and 76 cases/year, respectively. Therefore, we defined an optimal annual hospital threshold of 50 RCs/year, and we also used the threshold of 20 RCs/year proposed by the EAU guidelines to perform multiple patient-level analyses.

Results: 28,291 (29.5%) patients were operated in low- (< 20 RC/year), 49,616 (51.8%) in intermediate- (20-49 RC/year), and 17,934 (18.7%) in high-volume (≥ 50 RC/year) centers. After adjusting for major risk factors, high-volume centers were associated with lower inpatient mortality (OR 0.72, 95% CI 0.64-0.8, p < 0.001), shorter length of hospital stay (2.7 days, 95% CI 2.4-2.9, p < 0.001) and lower costs (457 Euros, 95% CI 207-707, p < 0.001) compared to low-volume centers. Patients operated in low-volume centers developed more perioperative complications such as transfusion, sepsis, and ileus.

Conclusions: Centralization of RC not only improves inpatient morbidity and mortality but also reduces hospital stay and costs. We propose a threshold of 50 RCs/year for optimal outcomes.

Keywords: Bladder cancer; Hospital caseload; Perioperative outcomes; Radical cystectomy; Urothelial carcinoma.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
The annual trends for radical cystectomy based on hospital caseload. The line represents the annual in-hospital mortality for all patients
See this image and copyright information in PMC

References

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