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THE IMPACT OF PROVIDER VOLUME ON OUTCOMES FROM UROLOGICAL CANCER THERAPY

2005; Lippincott Williams & Wilkins; Volume: 174; Issue: 2 Linguagem: Inglês

10.1097/01.ju.0000165340.53381.48

1527-3792

Fadi N. Joudi, Badrinath R. Konety,

Colorectal Cancer Surgical Treatments

No AccessJournal of UrologyReview Articles1 Aug 2005THE IMPACT OF PROVIDER VOLUME ON OUTCOMES FROM UROLOGICAL CANCER THERAPY FADI N. JOUDI and BADRINATH R. KONETY FADI N. JOUDIFADI N. JOUDI and BADRINATH R. KONETYBADRINATH R. KONETY View All Author Informationhttps://doi.org/10.1097/01.ju.0000165340.53381.48AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Growing evidence suggests an association between higher hospital and surgeon volumes, and better outcomes after high risk surgical procedures. We reviewed the literature on volume and outcomes, specifically in urological cancer therapy. Materials and Methods: We searched the literature from 1966 to 2004 using MEDLINE with the keywords outcomes, urology, neoplasms, volume, hospital volume, surgeon volume, prostatectomy, cystectomy, nephrectomy, prostate cancer, bladder cancer, kidney cancer and testis cancer. Relevant articles were reviewed and results were compared for each urological cancer. Results: Several studies demonstrated that higher hospital volume is associated with better outcomes for all urological cancer surgeries. We found that long-term morbidity associated with radical prostatectomy is significantly associated with individual surgeon volume. There were variations in outcome even among high volume surgeons, suggesting that surgical technique can independently impact outcome. Hospitals with a high volume of cystectomies and nephrectomies had decreased overall mortality rates compared with low volume hospitals. Patients undergoing retroperitoneal lymph node dissection for metastatic germ cell tumor had statistically significantly improved survival when treated at larger oncology centers. Conclusions: Evidence that high volume hospitals have better outcomes is increasing for urological cancer surgeries. Whether volume affects quality or better clinicians and services attract more patients can be debated. Centralizing health care will have major health policy implications, ie high volume hospitals may be overwhelmed and low volume hospitals may be at a disadvantage. An alternative would be to attempt to improve outcomes at low volume hospitals by identifying drivers of high quality care at high volume hospitals and transferring some of these characteristics. References 1 : Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med1979; 301: 1364. Google Scholar 2 : The volume-outcome relationship: practice-makes-perfect or selective-referral patterns?. Health Serv Res1987; 22: 157. Google Scholar 3 : Effects of surgeon volume and hospital volume on quality of care in hospitals. Med Care1987; 25: 489. Google Scholar 4 : Impact of hospital volume on operative mortality for major cancer surgery. JAMA1998; 280: 1747. 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Volume 174Issue 2August 2005Page: 432-438 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordsurogenital systemhospitalsurogenital neoplasmsoutcome assessment (health care)MetricsAuthor Information FADI N. JOUDI More articles by this author BADRINATH R. KONETY More articles by this author Expand All Advertisement PDF downloadLoading ...