Defining the minimum hospital case-load to achieve optimum outcomes in radical cystectomy.
OBJECTIVE
To define 'high-' and 'low-' volume hospitals for radical cystectomy, and the minimum caseload required for a hospital to achieve optimum outcomes, as a relationship between increasing surgical case volume and improved outcomes in radical urological surgery has been suggested in recent North American studies.


METHODS
All cystectomies for urological cancer in England over 5 years were analysed from Hospital Episode Statistics (HES) data. The data were analysed statistically to describe the relationship between each hospital's annual case volume and two outcome measures: in-hospital mortality rate (MR) and hospital stay.


RESULTS
In all, there were 6317 cystectomies in 210 centres, with an overall MR of 5.6%. There was a significant inverse correlation (-0.733, P < 0.01) between hospital case volume and MR. Applying 95% confidence intervals, the minimum caseload required to achieve optimum outcomes was 11 procedures/year. Increasing the caseload beyond this minimum did not produce a significant reduction in MR.


CONCLUSIONS
Analysis of HES data confirms an inverse relationship between hospital caseload and mortality for radical cystectomy. A caseload of 11 operations/year is associated with the lowest MR.
McCabe
John E
JE
Michael Heal Department of Urology, Leighton Hospital, Crewe, UK. johnemccabe@lineone.net
Jibawi
Abdullah
A
Javle
Pradip
P
D000368:Aged; D015653:Cystectomy / Q000401:mortality / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D017063:Outcome Assessment, Health Care; D014571:Urologic Neoplasms / Q000401:mortality / Q000601:surgery*; D016526:Workload / Q000706:statistics & numerical data*