uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population-based study
Skane Univ Hosp, Dept Urol, Jan Waldenstroms Gata 7, SE-20502 Malmo, Sweden;Lund Univ, Inst Translat Med, Jan Waldenstroms Gata 7, SE-20502 Malmo, Sweden.ORCID iD: 0000-0001-8193-0370
Reg Canc Ctr South, Lund, Sweden.
Linkoping Univ, Dept Clin & Expt Med, Div Urol, Linkoping, Sweden.
Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.
Show others and affiliations
2019 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 124, no 3, p. 449-456Article in journal (Refereed) Published
Abstract [en]

Objective

To investigate the association between hospital volume and overall survival (OS), cancer‐specific survival (CSS), and quality of care of patients with bladder cancer who undergo radical cystectomy (RC), defined as the use of extended lymphadenectomy (eLND), continent reconstruction, neoadjuvant chemotherapy (NAC), and treatment delay of <3 months.

Patients and Methods

We used the Bladder Cancer Data Base Sweden (BladderBaSe) to study survival and indicators of perioperative quality of care in all 3172 patients who underwent RC for primary invasive bladder cancer stage T1–T3 in Sweden between 1997 and 2014. The period‐specific mean annual hospital volume (PSMAV) during the 3 years preceding surgery was applied as an exposure and analysed using univariate and multivariate mixed models, adjusting for tumour and nodal stage, age, gender, comorbidity, educational level, and NAC. PSMAV was either categorised in tertiles, dichotomised (at ≥25 RCs annually), or used as a continuous variable for every increase of 10 RCs annually.

Results

PSMAV in the highest tertile (≥25 RCs annually) was associated with improved OS (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.75–1.0), whereas the corresponding HR for CSS was 0.87 (95% CI 0.73–1.04). With PSMAV as a continuous variable, OS was improved for every increase of 10 RCs annually (HR 0.95, 95% CI 0.90–0.99). Moreover, higher PSMAV was associated with increased use of eLND, continent reconstruction and NAC, but also more frequently with a treatment delay of >3 months after diagnosis.

Conclusions

The current study supports centralisation of RC for bladder cancer, but also underpins the need for monitoring treatment delays associated with referral.

Place, publisher, year, edition, pages
2019. Vol. 124, no 3, p. 449-456
Keywords [en]
hospital volume, radical cystectomy, survival, quality of care, #blcsm, #BladderCancer
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:uu:diva-394256DOI: 10.1111/bju.14767ISI: 000482452800019PubMedID: 30950568OAI: oai:DiVA.org:uu-394256DiVA, id: diva2:1360115
Funder
Swedish Cancer Society, CAN 2016/470Swedish Cancer Society, CAN 2017/278Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2019-10-11Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Authority records BETA

Malmström, Per-UnoHäggström, ChristelHolmberg, Lars

Search in DiVA

By author/editor
Liedberg, FredrikMalmström, Per-UnoHäggström, ChristelHolmberg, Lars
By organisation
UrologyEndocrine Surgery
In the same journal
BJU International
Urology and Nephrology

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 3 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf