title: Benefit in regionalisation of care for patients treated with radical cystectomy: a nationwide inpatient sample analysis.
abstract: OBJECTIVE
  To quantify in absolute terms the potential benefit of regionalisation of care from low- to high-volume hospitals.
  
  
  METHODS
  Patients with a primary diagnosis of bladder cancer treated with radical cystectomy (RC) were identified within the Nationwide Inpatient Sample, a retrospective observational population-based cohort of the USA, between 1998 and 2009. Intraoperative and postoperative complications, blood transfusions, prolonged length of stay, and in-hospital mortality rates represented the outcomes of interest. Potentially avoidable outcomes were calculated by subtracting predicted rates (i.e. estimated outcomes if care was delivered at a high-volume hospital) from observed rates (i.e. actual observed outcomes after care delivered at a low-volume hospital). Multivariable logistic regression models and number needed to treat were generated.
  
  
  RESULTS
  Patients treated at high-volume hospitals had lower odds of complications during hospitalisation than those treated in low-volume hospitals. Potentially avoidable intraoperative complications, postoperative complications, blood transfusions, prolonged hospitalisation, and in-hospital mortality rates were 0.6, 7.4, 2.8, 9.4, and 2.0%, respectively. This corresponds to a number needed to redirect from low- to high-volume hospitals in order to avoid one adverse event of 166, 14, 36, 11 and 50, respectively.
  
  
  CONCLUSIONS
  This is the first report to quantify the potential benefit of regionalisation of RC for muscle-invasive bladder cancer to high-volume hospitals.
authors.affiliation: West Middlesex University Hospital, London, UK.
authors.forename: Praful
authors.initials: P
authors.lastname: Ravi
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Jens
authors.initials: J
authors.lastname: Hansen
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Malek
authors.initials: M
authors.lastname: Meskawi
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
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
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D017052:Hospital Mortality / Q000639:trends; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay / Q000639:trends; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*
keywords: muscle-invasive bladder cancer; radical cystectomy; regionalisation