The connection between selective referrals for radical cystectomy and radical prostatectomy and volume-outcome effects: an instrumental variables analysis.
This study delineates the roles of "selective referrals" and "practice makes perfect" in the hospital procedure volume and in-hospital mortality association for radical cystectomy and radical prostatectomy. This is a retrospective analysis of the Nationwide Inpatient Sample (years 2000-2004). All hospitalizations with primary procedure codes for radical cystectomy and radical prostatectomy were selected. The association between hospital procedure volume and in-hospital mortality was examined using generalized estimating equations and by instrumental variables approaches. There was an inverse association between hospital procedure volume and in-hospital mortality for radical cystectomy (odds ratio = 0.57; 95% confidence interval = 0.38-0.87; P < .05). Results from the 2-stages least squares regression approach suggested that receiving treatment in high-volume hospitals decreased the probability of in-hospital mortality by 0.02 points, compared with 0.01 points using the ordinary least squares regression approach. Outcomes following radical cystectomy appear to be driven by "practice makes perfect."
Harvard School of Dental Medicine, Boston, MA 02115, USA. VA15@hsdm.harvard.edu
Veerasathpurush
V
Allareddy
Marcia M
MM
Ward
George L
GL
Wehby
Badrinath R
BR
Konety
D000368:Aged; D015653:Cystectomy / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011468:Prostatectomy / Q000401:mortality* / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012044:Regression Analysis