title: Impact of hospital volume on perioperative outcomes and costs of radical cystectomy: analysis of the Maryland Health Services Cost Review Commission database.
abstract: BACKGROUND
  The objective of this study was to evaluate the impact of hospital case volume on perioperative outcomes and costs of radical cystectomy (RC) after controlling for differences in patient case mix.
  
  
  METHODS
  The Maryland Health Services Cost Review Commission database was queried for patients who underwent an open RC between 2000 and 2011. Patients were divided into tertiles based on hospital case volume. Groups were compared for differences in length of intensive care unit (ICU) stay, length of total hospital stay, rate of in-hospital deaths and procedure-related costs.
  
  
  RESULTS
  In total, 1620 patients underwent a RC during the study period. Of these patients, 457 (28.2%) underwent surgery at 37 low volume centers, 465 (28.7%) at six mid volume centers and 698 (43.1%) at a single high volume center. The mean case volume of each group was 1.1, 7.0 and 63.5 RC/center/year, respectively. After controlling for marked differences in patient case mix, having surgery at the single high-volume center was independently associated with a decrease in length of ICU stay (coefficient = -0.41 days, 95% CI -0.78--0.05, p = 0.03), in-hospital mortality (OR 0.18, 95% CI 0.04-0.80, p = 0.02) and total medical costs (coefficient = -2.91k USD, 95% CI -4.15--1.67, p < 0.001). Decreased total costs were driven by reductions in charges associated with the operating room, drugs, radiology tests, labs, supplies and physical/occupational therapy (all p < 0.001).
  
  
  CONCLUSIONS
  Undergoing RC at a high volume medical center was associated with improved outcomes and reduced costs. These data support the centralization of RC to high volume centers.
authors: The Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors: Michael A
authors: MA
authors: Gorin
authors: Max
authors: M
authors: Kates
authors: Jeffrey K
authors: JK
authors: Mullins
authors: Phillip M
authors: PM
authors: Pierorazio
authors: Brian R
authors: BR
authors: Matlaga
authors: Mark P
authors: MP
authors: Schoenberg
authors: Trinity J
authors: TJ
authors: Bivalacqua
mesh_terms: D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data; D015653:Cystectomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D017722:Hospital Charges; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008396:Maryland; D008875:Middle Aged