title: Surgical caseload is an important determinant of continent urinary diversion rate at radical cystectomy: a population-based study.
abstract: BACKGROUND
  At radical cystectomy (RC), continent urinary diversion (CUD) provides functional outcomes that most closely approximate that of a native bladder. We tested the hypothesis that patients treated at high RC caseload hospitals and/or by high RC caseload surgeons have higher CUD rates.
  
  
  METHODS
  We identified 9,493 bladder cancer patients treated with RC between 1998 and 2007, within the Nationwide Inpatient Sample. Univariable and multivariable analyses tested the relationship between hospital and surgical caseload at RC, and CUD rate. Generalized estimating equations models were used to adjust for clustering among hospitals and surgeons.
  
  
  RESULTS
  Only 8% of patients received a CUD at RC. The CUD rate was 5 vs. 7 vs. 13% for low versus intermediate versus high annual hospital caseload (AHC) tertiles (P < 0.001). The CUD rate was 6 vs. 10 vs. 16% for low versus intermediate versus high annual surgical caseload (ASC) tertiles (P < 0.001). In multivariable analyses, and after adjusting for clustering, ASC emerged as independent predictors of CUD rate (P < 0.001), while AHC failed to achieve the independent predictor status for the same end point (P ≥ 0.1).
  
  
  CONCLUSIONS
  Our findings indicate that CUD is performed in a minority (8%) of RC patients. Surgical caseload represents an important determinant of CUD rate, while hospital caseload failed to achieve independent predictor status. Efforts should be made to optimize CUD rate a RC.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada. firas.abdollah@gmail.com
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Jan
authors.initials: J
authors.lastname: Schmitges
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thuret
authors.forename: Orchidee
authors.initials: O
authors.lastname: Djahangirian
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013043:Specialties, Surgical; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000601:surgery*; D014547:Urinary Diversion / Q000706:statistics & numerical data*; D016526:Workload