title: Benefit in regionalization of care for patients treated with nephrectomy: a Nationwide Inpatient Sample.
abstract: OBJECTIVE
  To provide in absolute terms a quantification of regionalization of care from low- to high-volume hospitals in patients treated with nephrectomy for non-metastatic renal cell carcinoma.
  
  
  METHODS
  Relying on the Nationwide Inpatient Sample, 48,172 patients with non-metastatic renal cell carcinoma undergoing nephrectomy were identified. All analyses focused on five specific endpoints: intraoperative complications, postoperative complications, blood transfusions, prolonged hospitalization, and in-hospital mortality. First, multivariable logistic regression models for prediction of the aforementioned endpoints were fitted among high-volume hospitals treated patients. Second, obtained coefficients from such models were applied onto low-volume hospitals treated individuals. Potentially avoidable events were computed through differences between observed and predicted adverse events. The number needed to treat was generated.
  
  
  RESULTS
  Low-volume hospitals treated individuals were between 11 and 28 % more likely to succumb to an adverse outcome (all P < 0.001). Differences between observed and predicted adverse outcome rates were all in favor of high-volume hospitals, except for in-hospital mortality. Potentially avoidable intraoperative complications, postoperative complications, blood transfusions, prolonged hospitalization, and in-hospital mortality rates were 1.4, 5.6, 7.6, 24.0, and 0.7 %, respectively. Thus, for every 71, 18, 13, 4, and 143 nephrectomies that are redirected to high-volume hospitals, 1 intraoperative complication, postoperative complication, blood transfusion, prolonged hospitalization, and in-hospital mortality could be potentially avoided.
  
  
  CONCLUSIONS
  Regionalization from low- to high-volume hospitals for patients undergoing a nephrectomy is associated with important benefits, for both the payer and patient's perspectives.
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal, QC, H2X 3J4, Canada, a.becker@uke.de.
authors: Andreas
authors: A
authors: Becker
authors: Marco
authors: M
authors: Bianchi
authors: Jens
authors: J
authors: Hansen
authors: Zhe
authors: Z
authors: Tian
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Ioana
authors: I
authors: Popa
authors: Paul
authors: P
authors: Perrotte
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: Pierre I
authors: PI
authors: Karakiewicz
authors: Maxine
authors: M
authors: Sun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D012041:Regional Medical Programs / Q000458:organization & administration*; D012189:Retrospective Studies; D014481:United States