title: Hospital and surgical caseload are predictors of comprehensive surgical treatment for bladder cancer: a population based study.
abstract: OBJECTIVE
  In patients with nonmetastatic muscle invasive bladder cancer, radical cystectomy and pelvic lymph node dissection represent a comprehensive surgical treatment. We tested the hypothesis that radical cystectomy performed at a high caseload hospital and/or by a high caseload surgeon is more likely to include pelvic lymph node dissection.
  
  
  METHODS
  We identified 12,274 patients with bladder cancer treated with radical cystectomy between 1998 and 2007 within the Nationwide Inpatient Sample. Univariable and multivariable analyses tested the relationship between hospital and surgical caseload at radical cystectomy, and the pelvic lymph node dissection rate. Generalized estimating equation models were used to adjust for clustering among hospitals and surgeons.
  
  
  RESULTS
  Overall 70% of patients received comprehensive surgical treatment defined as radical cystectomy and pelvic lymph node dissection. The pelvic lymph node dissection rate was 63% vs 67% vs 80% for low vs intermediate vs high annual hospital caseload tertiles, respectively (p<0.001). The pelvic lymph node dissection rate was 64% vs 68% vs 80% for low vs intermediate vs high annual surgical caseload tertiles, respectively (p<0.001). On multivariable analyses and after adjusting for clustering, annual hospital caseload and annual surgical caseload were independent predictors of the pelvic lymph node dissection rate.
  
  
  CONCLUSIONS
  Our findings indicate that a potentially comprehensive surgical treatment, defined as radical cystectomy with pelvic lymph node dissection, is only offered to a subset of patients. Annual hospital caseload and annual surgical caseload represent important determinants of potentially comprehensive bladder cancer surgery. Efforts should be made to ensure that virtually all patients with bladder cancer receive comprehensive surgical treatment.
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: Jan
authors.initials: J
authors.lastname: Schmitges
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
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: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
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: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000706:statistics & numerical data*; D005544:Forecasting; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000601:surgery*