Udovicich Cristian, Perera Marlon, Huq Molla, Wong Lih-Ming, Lenaghan Daniel
Department of Urology, St Vincent's Hospital, Melbourne, Vic., Australia.
Department of Surgery, Western Health, Melbourne, Vic., Australia.
BJU Int. 2017 May;119 Suppl 5:26-32. doi: 10.1111/bju.13827.
To evaluate the association between hospital volume and perioperative outcomes of radical cystectomy (RC) using state population data for a contemporary Australian cohort.
Patients undergoing RC for urothelial malignancy in the state of Victoria, Australia between July 2003 and June 2014 were identified using the Victorian Admitted Episodes Dataset (VAED). Hospitals were divided into tertiles according to their caseload per year. Hospitals performing <4 RCs/year were defined as low-volume hospitals (LVH), 4-10 RCs/year as medium-volume hospitals (MVH), and >10 RCs/year as high-volume hospitals (HVH). Perioperative outcomes derived included: in-hospital mortality (IHM), prolonged length of stay (LOS; >14 days), prolonged intensive care unit (ICU) admission (>24 h), and requirement for blood transfusion. The relationship between hospital volume and perioperative outcomes was assessed using logistic regression.
During the 11-year study period, 803 patients underwent RC for bladder cancer. The overall IHM rate was 2.2% (LVH 3.7%, MVH 2.5%, HVH 0.9%). Other outcomes observed were prolonged LOS (45%), prolonged ICU admission (31%) and requirement for blood transfusion (56%). On multivariate analysis, LVH was found to be associated with increased IHM (odds ratio [OR] 5.74, P = 0.04) and prolonged ICU admission (OR 11.58, P < 0.001) when compared to HVH. There was a lower rate of prolonged LOS for LVH (OR 0.60, P = 0.01). No significant relationship was identified for LVH and blood transfusion.
Perioperative outcomes in Victoria are comparable to international standards. Our results add further population study evidence to the volume-outcome relationship in RC. There was a significant association between LVH and both IHM and prolonged ICU admission. This subgroup of patients would appear to benefit from transfer of care to a HVH. The role of centralisation of RC in Australia should be further considered.
利用澳大利亚当代队列的州人口数据，评估医院手术量与根治性膀胱切除术（RC）围手术期结局之间的关联。
利用维多利亚州住院病例数据集（VAED）确定2003年7月至2014年6月期间在澳大利亚维多利亚州因尿路上皮恶性肿瘤接受RC的患者。医院根据每年的病例量分为三分位数。每年进行少于4例RC的医院被定义为低手术量医院（LVH），每年进行4至10例RC的医院为中等手术量医院（MVH），每年进行超过10例RC的医院为高手术量医院（HVH）。得出的围手术期结局包括：住院死亡率（IHM）、住院时间延长（LOS；>14天）、重症监护病房（ICU）住院时间延长（>24小时）以及输血需求。采用逻辑回归评估医院手术量与围手术期结局之间的关系。
在11年的研究期间，803例患者因膀胱癌接受了RC。总体IHM率为2.2%（LVH为3.7%，MVH为2.5%，HVH为0.9%）。观察到的其他结局包括住院时间延长（45%）、ICU住院时间延长（31%）以及输血需求（56%）。多变量分析显示，与HVH相比，LVH与IHM增加（比值比[OR]5.74，P = 0.04）和ICU住院时间延长（OR 11.58，P < 0.001）相关。LVH的住院时间延长率较低（OR 0.60，P = 0.01）。未发现LVH与输血之间存在显著关系。
维多利亚州的围手术期结局与国际标准相当。我们的结果为RC手术量 - 结局关系增添了更多人群研究证据。LVH与IHM和ICU住院时间延长均存在显著关联。这一亚组患者似乎可从转诊至高手术量医院接受治疗中获益。应进一步考虑在澳大利亚将RC手术集中化的作用。
