title: Is there a relationship between leapfrog volume thresholds and perioperative outcomes after radical cystectomy?
abstract: OBJECTIVE
  Threshold levels for hospital volume (HV), defined by the Leapfrog Group for Patient Safety, advocate the concentration of high-risk medical care to high-volume hospitals in order to avail of these outcome benefits. We explored the effect of Leapfrog volume thresholds (LVT) on 5 short-term radical cystectomy (RC) outcomes.
  
  
  METHODS
  Within the Health Care Utilization Project Nationwide Inpatient Sample, we focused on RCs performed between 2001 and 2007. We tested the rates of in-hospital mortality, intraoperative and postoperative complications, blood transfusions, as well as length of stay, stratified according to the number of LVT met. Multivariable regression analyses further adjusted for potential confounders.
  
  
  RESULTS
  Overall, 28.6%, 17.1%, 18.8%, 17.0%, 15.4%, and 3.1% of cases were performed at institutions reaching 0, 1, 2, 3, 4, and 5 LVT, respectively. Patients treated at institutions reaching 5 LVT had fewer comorbidities, were younger, and more likely to hold private insurance, relative to patients treated at institutions reaching 0 LVT. In adjusted analyses, after accounting for patient characteristics and HV, LVT status was inversely related to mortality (P = 0.030), intraoperative (P = 0.042) and postoperative (P = 0.041) complications, as well as the likelihood of blood transfusion (P<0.001).
  
  
  CONCLUSIONS
  LVT is an important determinant of the risk of mortality, complications, and blood transfusions after RC, independent of HV. These findings hint at intrinsic structural and procedural elements available within hospitals that meet LVT, which enable them to manage complications, and prevent mortality, in a more optimal manner.
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada. Electronic address: mcw.sun@umontreal.ca.
authors: Maxine
authors: M
authors: Sun
authors: Department of Urology, University of Cambridge, Cambridge, UK.
authors: Praful
authors: P
authors: Ravi
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
authors: Pierre I
authors: PI
authors: Karakiewicz
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Shyam
authors: S
authors: Sukumar
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Jesse
authors: J
authors: Sammon
authors: Department of Urology, Universita Vita Salute San Raffaele, Milan, Italy.
authors: Marco
authors: M
authors: Bianchi
authors: Department of Urology, Weill Medical College of Cornell University, New York, NY.
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Wooju
authors: W
authors: Jeong
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Khurshid R
authors: KR
authors: Ghani
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Jens
authors: J
authors: Hansen
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Ariella
authors: A
authors: Friedman
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
authors: Paul
authors: P
authors: Perrotte
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: James O
authors: JO
authors: Peabody
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Mani
authors: M
authors: Menon
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Quoc-Dien
authors: QD
authors: Trinh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012044:Regression Analysis; D016896:Treatment Outcome; D014481:United States; D016270:United States Agency for Healthcare Research and Quality; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*
keywords: Bladder neoplasms; Complication; Cystectomy; Leapfrog; Regionalization