Impact of provider volume on operative mortality after radical cystectomy in a publicly funded healthcare system

Authors

  • Girish S. Kulkarni Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; and Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada; and Institute for Clinical Evaluative Sciences, Toronto, Canada
  • David R. Urbach Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; and Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada; and Institute for Clinical Evaluative Sciences, Toronto, Canada
  • Peter C. Austin Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; and Institute for Clinical Evaluative Sciences, Toronto, Canada
  • Neil E. Fleshner Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
  • Andreas Laupacis Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; and Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, University of Toronto, Toronto, Canada; and Institute for Clinical Evaluative Sciences, Toronto, Canada

DOI:

https://doi.org/10.5489/cuaj.361

Keywords:

Bladder Cancer, Cystectomy, Operative Mortality, Volume

Abstract

Introduction: 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.

 

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Published

2013-12-05

How to Cite

Kulkarni, G. S., Urbach, D. R., Austin, P. C., Fleshner, N. E., & Laupacis, A. (2013). Impact of provider volume on operative mortality after radical cystectomy in a publicly funded healthcare system. Canadian Urological Association Journal, 7(11-12), 425–9. https://doi.org/10.5489/cuaj.361

Issue

Section

Original Research