Spanish study directly links surgical volume with mortality in bladder cancer patients undergoing cystectomy

In a retrospective study of 12,154 radical cystectomies performed in 196 Spanish hospitals, the authors uncovered a highly significant relationship between patient volume per hospital and 90-day mortality.

Dr Ana Guijarro Cascales (Hospital Universitario Fundacion Alcorcon, Spain) examined the national registry of Spain from 2011-2015 for the impact of the number of radical cystectomies performed per hospital on 90-day mortality. In the literature, 90-day mortality is variable but generally thought to relate to number of patients treated per year, and reported to be 2.3-7.9% [1]. The majority of hospitals do less than 10 radical cystectomies per year (191/196), with only 5 hospitals performing more than 38 per year. Across all Spanish hospitals, median mortality at 30, 60, and 90 days was respectively 2.9%, 5.2%, and 6.5%.

However, at the five higher volume centres (38+ radical cystectomies per year) the mortality rate at 90 days was just 3.3%. By extrapolation, every additional 10 radical cystectomies performed per year in a given hospital will decrease 90-day mortality by 20% (P<0.001). These data should support the centralisation of radical cystectomy surgery.

1. Marqueen et al. JNCI Cancer Spectr. 2018 Nov;2(4):pky075.

Posted on 21 May, 201917 March, 2021