scholarly journals Association between Transplant Volumes and 30-Day Readmissions Following Allogeneic Hematopoietic Cell Transplantation (allo-HCT) in the US

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 617-617
Author(s):  
Binod Dhakal ◽  
Smith Giri ◽  
Adam Levin ◽  
Rein Lisa ◽  
Timothy S. Fenske ◽  
...  
Keyword(s):  
Research Funding ◽  
High Volume ◽  
Medicare Beneficiaries ◽  
Case Volume ◽  
Readmission Rates ◽  
Stem Cell Source ◽  
Co Morbidity ◽  
Equity Ownership ◽  
Low Volume ◽  
Morbidity Index

Abstract Background: Readmissions within 30 days after index hospitalization is a quality and cost-containment metric. Financial penalties to hospitals with high rates of risk-adjusted readmissions have been expanded beyond medical conditions like heart failure and pneumonia. Published data show significant heterogeneity in readmission rates and recent data from elderly Medicare beneficiaries reported a 17.8% readmission rate for targeted conditions. Allo-HCT is a widely used therapeutic strategy in the management of various hematologic disorders like acute myelogenous (AML) and lymphoblastic leukemia (ALL). However, allo-HCT readmission rates are poorly described, and limited to single center studies only. The association between institution HCT volume and 30-day readmission metric has not been examined. Methods: In this observational study, we used the 2012-2014 Nationwide Readmission Database (NRD) to identify hospitals with established allo-HCT programs. Patients ≥18 years of age, discharged from hospital following an allo-HCT (identified using ICD-9 procedure code of 41.02, 41.03, 41.05, 41.06, or 41.08) were included. Annual hospital case volume was calculated as the sum of all discharges with allo-HCT within the calendar year; low, medium, and high annual case volume groups were created based on (survey weighted) tertiles of patients (pts.) in the analytic data domain (Figure 1). Rates, causes, and costs of 30-day readmissions were compared between low-, medium-, and high-volume hospitals. The analysis was limited to urban teaching hospitals and pts. admitted during month of December were excluded. The primary outcome, was the unplanned 30-day re-admission following allo-HCT. Multiple logistic regression was used to model each 30-day readmission outcome including hospital case volume with other predictors (age, sex, disease type, stem cell source, co-morbidity index, primary insurance, length of stay, infection and acute graft-versus-host-disease (aGVHD) at index admission, discharge disposition and median income quartile). Results: A total of 17,214 (weighted) allo-HCTs were performed during the time period. Baseline characteristics of pts. in low (<58 allo-HCTs/yr.)-, medium (58-158 allo-HCTs/yr.)- and high-volume (>158 allo-HCTs/yr.) hospitals were comparable as shown in Table 1. The overall rates of readmissions were significantly higher in low volume centers (24.7.4%; SE, 1.5) compared to medium (21.4% (1.7) and high volume (9.5% (1.8), centers (p=0.03). The mean time to readmission in low vs. medium vs. high volume centers was, 11.6 [0.39] days vs. 12 [0.26] days vs. 11.5 [0.57] days respectively, (p <0.001). The length of readmission stay was significantly longer in low volume centers (mean [SD], 12.8 [0.64] days vs. 12.3 [0.91] days vs. 10.6 [0.80] days; p=<0.001) respectively. Consequently, cost per readmission was significantly higher in low volume centers (mean [SD], $164,349 [12,328] vs. $140,327 [15,297] vs. $107,362 [11,665]; p<0.001). Readmission rates in low volume and medium volume centers compared to high volume centers were: adjusted odds ratio (aOR) 1.39, 95% CI 1.08-1.77; p =0.01 and 1.18, 95% CI, 0.89-1.55; p=0.23, respectively. Other significant predictors of readmission included disease type (ALL vs. AML): aOR 1.32, 95% CI 1.07-1.63; p= 0.009), type of primary insurance (Medicare vs. private): aOR 1.17, 95% CI 1.01-1.35; p=0.02; Elixhauser co-morbidity index (≥1 vs. 0): aOR 1.4, 95% CI 1.2-1.7; p= 0.001 and stem cell source (cord blood vs. peripheral blood; aOR 2.4, 95%CI 1.85-3.2, p<0.001). Patients with any infection and the presence of aGVHD at index admission did not have an effect on readmission rates. Neutropenia, fever, viral infection, sepsis, acute renal failure, and pneumonia were the most common reasons for readmission. Conclusions: The likelihood of readmission after allo-HCT is elevated in centers performing <58 allo-HCTs/year, in those pts. with ≥1 co-morbidities, cord blood transplants, in ALL pts. and in Medicare beneficiaries. Lower readmission at higher-volume centers was associated with significantly lower cost to the health care system. There are important limitations with the use of data from NRD particularly the lack of information on donor status and conditioning regimen. Despite these shortcomings, the information may aid health care when developing quality-of-care metric for allo-HCT. Disclosures Dhakal: Amgen: Honoraria; Takeda: Honoraria; Celgene: Consultancy, Honoraria. Shah:Geron: Equity Ownership; Lentigen Technology: Research Funding; Juno Pharmaceuticals: Honoraria; Oncosec: Equity Ownership; Miltenyi: Other: Travel funding, Research Funding; Exelexis: Equity Ownership. D'Souza:Prothena: Consultancy, Research Funding; Takeda: Research Funding; Celgene: Research Funding; Merck: Research Funding; Amgen: Research Funding. Hari:Celgene: Consultancy, Honoraria, Research Funding; Janssen: Honoraria; Bristol-Myers Squibb: Consultancy, Research Funding; Kite Pharma: Consultancy, Honoraria; Sanofi: Honoraria, Research Funding; Amgen Inc.: Research Funding; Takeda: Consultancy, Honoraria, Research Funding; Spectrum: Consultancy, Research Funding. Hamadani:Sanofi Genzyme: Research Funding, Speakers Bureau; MedImmune: Consultancy, Research Funding; Celgene Corporation: Consultancy; Takeda: Research Funding; Cellerant: Consultancy; ADC Therapeutics: Research Funding; Ostuka: Research Funding; Janssen: Consultancy; Merck: Research Funding.

scholarly journals Incidence and Predictors of 30-Day Readmissions Following Autologous Hematopoietic Cell Transplantation (auto-HCT) in the US

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3544-3544
Author(s):  
Binod Dhakal ◽  
Smith Giri ◽  
Adam Levin ◽  
Rein Lisa ◽  
Timothy S. Fenske ◽  
...  
Keyword(s):  
Research Funding ◽  
High Volume ◽  
Disease Type ◽  
Index Hospitalization ◽  
Case Volume ◽  
Readmission Rates ◽  
Co Morbidity ◽  
The Us ◽  
Equity Ownership ◽  
Low Volume

Abstract Background: Readmissions within 30 days after index hospitalization is a quality, and cost-containment metric. It is now a major issue for hospitals, physicians and policy makers. Financial penalties to hospitals with high rates of risk adjusted readmissions have been expanded beyond medical conditions like heart failure and pneumonia. Auto-HCT is a widely used therapeutic strategy in the management of various hematological disorders, particularly multiple myeloma (MM) and non-Hodgkin lymphoma (NHL) in the US. However, auto-HCT readmission rates are poorly described in the literature and often limited to single center studies. To better address the incidence and underlying predictors of 30-day readmission following auto-HCT, we performed an analysis of the Nationwide Readmission Database(NRD). Methods: NRD data was queried from 2012-2014 to identify patients >18 years of age discharged from the hospital after auto-HCT (identified as presence of any ICD-9 procedure codes 41.00, 41.01, 41.04, 41.07, or 41.09). Survey weighted domain analysis was conducted to study incidence of 30-day readmission by center volume. Annual hospital case volume was calculated as the sum of all discharges with auto-HCT within the calendar year; low, medium, and high annual case volume groups were created based on (survey weighted) tertiles of patients (pts.) in the analytic data domain (Figure 1). Rates, causes, and costs of 30-day readmissions were compared between low-, medium-, and high-volume hospitals. The analysis was limited to urban teaching hospitals, and pts. admitted during month of December were excluded. The primary outcome was the unplanned 30-day re-admission following auto-HCT. Multiple logistic regression was used to model each 30-day readmission outcome including hospital case volume with other predictors (age, sex, disease type, primary insurance, median income, discharge disposition, co-morbidity, length of stay (LOS) and infection at index hospitalization). Results: A total of 28,356 (weighted) auto-HCTs were performed during the time period and MM remains the most common indication (~60%). Baseline characteristics of pts. in low (<78/yr.)-, medium (78-187/yr.)- and high-volume (>187/yr.) hospitals were comparable as shown in Table 1. The overall rates of readmissions were significantly higher in low volume 15.7% (SE, 1.5) compared to medium 9.9% (1.5) and high volume 9.5% (1.8), p=0.002 centers. The mean time to readmission in low vs. medium vs. high volume centers was (8.3 [0.41] days vs. 10.7 [0.78] days vs. 8.9 [0.26] days; p <0.001); however, readmission LOS was significantly longer in low and medium volume centers (mean [SD], 7.2 [0.30] days vs. 8.3 [0.62] days vs. 6.2 [0.25] days; p=<0.001) respectively. Consequently, cost per readmission was significantly higher in low volume centers (mean [SD], $ 65,815 [3492] vs. $ 65,662 [5896] vs. $ 48,914 [4162]; p<0.001). Readmission rates in low volume and medium volume centers compared to high volume centers were: adjusted odds ratio (aOR) 1.68, 95% CI 1.07-2.6; p =0.02 and 1.06 95% CI, 0.61-1.83; p=0.82, respectively. Other significant predictors of readmission included younger age (≥50 vs. <49) (aOR 0.81, 95% CI 0.68-0.98; p=0.03), female sex (aOR 1.20, 95% CI 1.06-1.36; p=0.003), disease type (others vs. MM) (aOR 1.37 95% CI 1.07-1.55; p= 0.018); and Elixhauser co-morbidity index (≥20 vs. 0; aOR 1.5, 95% CI 1.16-1.92; p= 0.00). Patients with non-routine discharges (discharges other than home) (aOR 1.3, 95% CI 1.1-1.7, p= 0.005), and shorter index LOS (aOR 0.94, 95% CI 0.89-0.98; p=0.01) were associated with higher readmission rates. The most common causes of readmission included: fever, neutropenia, infections, pneumonia, hyovolemia, nausea, vomiting and acute kidney injury. Conclusions: This is the largest study till date reporting on the incidence and predictors of 30-day readmissions following auto-HCT in the US. The overall 30-day readmission rates following auto-HCT was ~12%. We report an inverse association with hospital auto-HCT volume (<78/yr.) and 30-day readmissions. Shorter LOS at index admission was associated with higher rates of readmission, which was associated with significantly higher cost to the health care system. These data should provide guidance when developing quality indicators and any policies penalizing hospitals for auto-HCT readmission. Disclosures Dhakal: Celgene: Consultancy, Honoraria; Takeda: Honoraria; Amgen: Honoraria. Shah:Lentigen Technology: Research Funding; Oncosec: Equity Ownership; Exelexis: Equity Ownership; Miltenyi: Other: Travel funding, Research Funding; Juno Pharmaceuticals: Honoraria; Geron: Equity Ownership. D'Souza:Takeda: Research Funding; Merck: Research Funding; Celgene: Research Funding; Prothena: Consultancy, Research Funding; Amgen: Research Funding. Hari:Spectrum: Consultancy, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; Kite Pharma: Consultancy, Honoraria; Sanofi: Honoraria, Research Funding; Janssen: Honoraria; Amgen Inc.: Research Funding; Celgene: Consultancy, Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding. Hamadani:Celgene Corporation: Consultancy; Ostuka: Research Funding; Cellerant: Consultancy; ADC Therapeutics: Research Funding; Janssen: Consultancy; MedImmune: Consultancy, Research Funding; Sanofi Genzyme: Research Funding, Speakers Bureau; Takeda: Research Funding; Merck: Research Funding.

Predictors of rectal cancer resection at high-volume hospitals among Medicare patients.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 808-808
Author(s):  
Mary E. Charlton ◽  
Catherine Chioreso ◽  
Irena Gribovskaja-Rupp ◽  
Chi Lin ◽  
Marcia M Ward ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Rectal Adenocarcinoma ◽  
High Volume ◽  
Neoadjuvant Chemoradiation ◽  
Sphincter Preservation ◽  
Cancer Center ◽  
Medicare Beneficiaries ◽  
Co Morbidity ◽  
High Volume Hospital ◽  
Low Volume

808 Background: Hospitals that perform high volumes of rectal cancer resections achieve superior rates of sphincter preservation and survival compared to those that do not, but many rectal cancer resections are still performed in low-volume centers. We aimed to determine the patient, provider and pathway characteristics associated with receipt of surgery from high-volume hospitals. Methods: Patient and provider characteristics were extracted from the SEER-Medicare database for Medicare beneficiaries (age 66+) with stage II/III rectal adenocarcinoma diagnosed 2007-2011 who received rectal cancer-directed surgery. Hospitals were divided into quartiles by volume of rectal cancer resections, and were also classified by NCI cancer center designation. Results: 2056 patients were included, and 57% received surgery in a high-volume hospital or NCI-designated center. Those residing in census tracts classified as rural and having higher median incomes, lower poverty, and higher levels of education more frequently received surgery in high-volume hospitals; there were no differences by age, gender, stage, or co-morbidity status. 55% of patients received surgery at the same facility where they received the colonoscopy that identified their cancer. In multivariate analyses, the strongest predictor of receiving one’s surgery in a high-volume hospital was receipt of colonoscopy at a high-volume facility (OR = 3.75, 95% CI: 2.93-4.79). Those treated in high-volume hospitals more often had guideline-recommended staging (TRUS/MRI) and treatment (neoadjuvant chemoradiation). Conclusions: Rectal cancer patients tended to stay at the facility where their cancer was diagnosed; and did not typically seek out high-volume providers if their colonoscopy was performed in a low-volume facility. This suggests that colonoscopists may have substantial influence over where patients receive surgery. Given that rurality, income and education appear to more strongly predict receipt of surgery at a high-volume hospital compared to clinical characteristics, further research is needed to understand considerations driving patient decisions and referring providers’ recommendations for care.

Is Outcome after Blunt Splenic Injury in Adults Better in High-Volume Trauma Centers?

2005 ◽  
Vol 71 (11) ◽  
pp. 942-949 ◽  
Author(s):  
Brian G. Harbrecht ◽  
Mazen S. Zenati ◽  
Louis H. Alarcon ◽  
Juan B. Ochoa ◽  
Juan C. Puyana ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Center ◽  
Injury Severity ◽  
Trauma System ◽  
High Volume ◽  
Trauma Centers ◽  
Case Volume ◽  
Center Volume ◽  
Low Volume ◽  
Outcome Differences

An association between outcome and case volume has been demonstrated for selected complex operations. The relationship between trauma center volume and patient outcome has also been examined, but no clear consensus has been established. The American College of Surgeons (ACS) has published recommendations on optimal trauma center volume for level 1 designation. We examined whether this volume criteria was associated with outcome differences for the treatment of adult blunt splenic injuries. Using a state trauma database, ACS criteria were used to stratify trauma centers into high-volume centers (>240 patients with Injury Severity Score >15 per year) or low-volume centers, and outcome was evaluated. There were 1,829 patients treated at high-volume centers and 1,040 patients treated at low-volume centers. There was no difference in age, gender, emergency department pulse, emergency department systolic blood pressure, or overall mortality between high- and low-volume centers. Patients at low-volume centers were more likely to be treated operatively, but the overall success rate of nonoperative management between high-and low-volume centers was similar. These data suggest that ACS criteria for trauma centers level designation are not associated with differences in outcome in the treatment of adult blunt splenic injuries in this regional trauma system.

scholarly journals Impact of case volume per year on flexible Ureteroscopy practice: an internet based survey

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Omar Alhunaidi ◽  
Abdulrahman A. Ahmad ◽  
Ahmed R. EL-Nahas ◽  
Bader Akroof ◽  
Ali Alamiri ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Group Versus ◽  
High Volume ◽  
Internet Survey ◽  
Flexible Ureteroscopy ◽  
Ureteral Stones ◽  
Case Volume ◽  
Ureteral Access Sheath ◽  
Volume Group ◽  
Low Volume

Abstract Background To report current worldwide variation in techniques and clinical practice of flexible ureteroscopy (FURS) among endourologists of different case volumes per year. Methods Two invitations to complete an internet survey were emailed to Endourological Society members. Some of survey questions asked about indications of using FURS for renal and upper ureteral stones. Others were concerned with clinical practice of FURS (such as preoperative stenting, use of ureteral access sheath (UAS) and safety guidewire, technique of Laser lithotripsy and fragment retrieval, and post-FURS stenting. Responders were distributed into two groups; high-volume (> 100 cases/year) and low-volume surgeons (< 100 cases/year) and data were compared between both groups. Results Responses were received from 146 endourologists all over the world (62 high-volume and 84 low-volume). FURS for intrarenal stone > 20 mm was used by 61% of high-volume surgeons compared with 28.6% for low-volume (P < 0.001). Semirigid URS was used for upper ureteric stones in 68% among high-volume group and 82% in low-volume group (P = 0.044). UAS was used by 62% in low-volume group and 69% in high volume group (P = 0.516). Laser stone dusting was preferred by 63% in low-volume group versus 45% by high-volume (P = 0.031). More responders in low-volume group preferred to leave the stent for 6 weeks (P = 0.042). Conclusions The use of FURS for treating upper tract calculi has expanded by high volume endourologists to include large renal stones > 20 mm. Low-volume surgeons prefer to use semi-rigid URS for treatment of upper ureteral stones, to apply Laser stone dusting and maintain ureteral stents for longer periods.

scholarly journals Real-World Treatment Patterns and Overall Survival Among Medicare Fee-for-Service Beneficiaries Newly Diagnosed with Peripheral T-Cell Lymphoma

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3492-3492
Author(s):  
Anne Shah ◽  
Allison Petrilla ◽  
Mayvis Rebeira ◽  
Joseph Feliciano ◽  
Thomas W. LeBlanc ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Research Funding ◽  
Brentuximab Vedotin ◽  
Treatment Patterns ◽  
Fee For Service ◽  
Newly Diagnosed ◽  
Medicare Beneficiaries ◽  
Employment Equity ◽  
Advisory Committees ◽  
Equity Ownership

Background: Peripheral T-cell lymphomas (PTCL) are a rare and heterogeneous group of lymphoid malignancies characterized by a clinically aggressive course with poor prognosis. A majority of PTCL patients are ≥60 years of age and typically present with advanced stage disease and multiple comorbidities. There remains no consensus standard of care for patients with most PTCL subtypes. Multi-agent chemotherapy, consisting of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or CHOP with etoposide (CHOEP), are guideline recommended options for nodal subtypes. Limited contemporary real-world data exist on the treatment patterns and overall survival (OS) of PTCL patients treated with CHOP or non-CHOP regimens in the United States before the FDA approval of brentuximab vedotin in combination with chemotherapy in November 2018 based on the ECHELON-2 trial. Objective: To evaluate treatment patterns and OS prior to the approval of brentuximab vedotin among Medicare Fee-for-Service (FFS) beneficiaries newly diagnosed with PTCL. Methods: The 100% sample of Medicare FFS claims (Parts A/B/D) was used to identify patients aged ≥65 years with ≥1 inpatient or ≥2 distinct outpatient diagnosis claims for PTCL (index event) from January 2011 to December 2017. Patients were required to have a least 6 months prior and 12 months post-index continuous Medicare enrollment, and were followed until disenrollment, death, or the end of the study period, whichever occurred first. OS, defined as the time from initial episode or treatment start date to the validated date of death, was measured using the Kaplan-Meier method; patients without a death date were assumed to be alive at the time of analysis and were censored. Results: A total of 2551 Medicare FFS beneficiaries with a PTCL diagnosis met study criteria and were included for analysis. The majority of patients were white (86.9%), over half were male (52.9%), and mean age was 75 years. Patients had multiple comorbidities at diagnosis (Charlson Comorbidity Index (CCI) score 4.47), including hypertension (77.3%), diabetes (32.9%), and chronic obstructive pulmonary disease (28.1%). Among the 2551 patients in the study cohort, 62.4% (n=1593 of 2551) received at least one identifiable drug regimen; 25.5% of treated patients received CHOP (n=407), 3.1% CHOEP (n=50) and 71.2% (n=1134) other regimens. Of patients treated with other regimens, 37.7% (n=427) received steroids only, 22.4% (n=254) steroids with unidentifiable chemotherapy, 6.9% (n=78) cyclophosphamide, 6.2% (n=70) methotrexate, 4.6% (n=52) brentuximab vedotin, 3.6% (n=41) bendamustine, 3.5% (n=40) romidepsin, and 15.2% (n=172) other therapy combinations. Among patients who were treated with CHOP, 16.6% (n=66) received an identifiable second line of therapy (LoT), 48.7% (n=194) an unidentifiable second LoT, and the remainder (34.7%, n=138) had no evidence of further anti-cancer treatment. The median time from CHOP initiation to a subsequent LoT was 5.6 months. The mean baseline CCI score for patients treated with CHOP was 4.33 (±2.93) compared with 4.76 (±2.97) for patients treated with other therapies (p=0.0118). In patients receiving an identifiable first LoT, median OS among CHOP and non-CHOP recipients was 4.8 years (95% CI 3.0-6.1) and 4.4 years (95% CI 3.0-4.9), respectively (Table). The 5-year OS estimate was 49% in patients receiving CHOP compared with 46% for non-CHOP recipients. Conclusions: Fewer than 30% of Medicare beneficiaries newly diagnosed with PTCL were treated with intensive chemotherapy as first LoT. Acknowledging a possible selection bias for more fit PTCL patients receiving CHOP, this group had increased OS compared with patients receiving non-CHOP therapy. However, the 5-year OS across all cohorts was less than 50%. New therapies such as brentuximab vedotin may fill the need for PTCL Medicare beneficiaries who may not be able to tolerate CHOP or CHOP-based regimens. Disclosures Shah: Avalere Health, An Inovalon Company: Employment. Petrilla:Avalere Health, An Inovalon Company: Employment. Rebeira:Seattle Genetics: Employment. Feliciano:Seattle Genetics: Employment, Equity Ownership. LeBlanc:Astra Zeneca: Consultancy, Research Funding; Duke University: Research Funding; Jazz Pharmaceuticals: Research Funding; Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees; Helsinn: Consultancy; Agios: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; NINR/NIH: Research Funding; Amgen: Membership on an entity's Board of Directors or advisory committees; AbbVie: Membership on an entity's Board of Directors or advisory committees; Otsuka: Consultancy, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Research Funding; CareVive: Consultancy; Celgene: Honoraria; Flatiron: Consultancy; American Cancer Society: Research Funding; Heron: Membership on an entity's Board of Directors or advisory committees; Medtronic: Membership on an entity's Board of Directors or advisory committees; Pfizer Inc: Consultancy. Lisano:Seattle Genetics, Inc.: Employment, Equity Ownership.

Impact of radiotherapy facility volume on the management and survival of patients with muscle-invasive bladder cancer receiving bladder-preserving therapy.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 18-18
Author(s):  
Kevin D'Rummo ◽  
Mindi TenNapel ◽  
Xinglei Shen
Keyword(s):  
Bladder Cancer ◽  
Charlson Comorbidity Index ◽  
High Volume ◽  
Case Volume ◽  
Muscle Invasive Bladder Cancer ◽  
Bladder Preservation ◽  
Nccn Guidelines ◽  
Comorbidity Index ◽  
Low Volume ◽  
Muscle Invasive

18 Background: Higher facility surgical volume predicts for improved survival in patients with muscle-invasive bladder cancer (MIBC) who undergo radical cystectomy. Here, we investigated the association between facility radiotherapy (RT) case volume and compliance with National Comprehensive Cancer Network (NCCN) guidelines as well as overall survival (OS) for patients with MIBC receiving radiation-based bladder preservation. Methods: The National Cancer Database (NCDB) was used to identify patients who were diagnosed with non-metastatic MIBC from 2004 to 2015 and received RT at the reporting institution. Patient, tumor, and treatment characteristics were recorded. Facility RT case volume was defined as the summed MIBC cases treated with RT during the study period. Facilities were divided into high or low volume groups at the 80th percentile of RT case volume. We compared compliance with NCCN guidelines regarding total RT dose of at least 55 Gy, use of TURBT prior to RT, and planned use of concurrent chemotherapy using the χ2 test. OS was assessed using Kaplan-Meier method. A Cox proportional hazard model was used to evaluate predictors of survival. Results: There were 7,562 included patients, and 3,816 (50.5%) were treated at a high-volume center. Median RT case volume was 21 for high-volume centers versus 8 cases for low-volume centers. Higher rates of compliance with all three NCCN recommendations were observed at high-volume centers (48% vs 41%, P< .0001). Age, sex, tumor stage, nodal status, Charlson Comorbidity Index, insurance status, and use of a TURBT prior to RT were predictive of survival. Volume as a continuous variable was an independent predictor of OS ( P= .002). Treatment at a high-volume facility was associated with significantly greater OS for all patients (log-rank P= .001), including patients with a Charlson Comorbidity Index of 0 ( P= .012). Further division of facilities into quartiles revealed incremental improvement in OS with higher facility volume ( P= .001). Conclusions: Bladder preservation treatment at a high-volume facility is associated with greater guideline-concordant management and improved OS among patients with MIBC.

scholarly journals Association between operation volume and postoperative mortality in elective endovascular repair of infrarenal abdominal aortic aneurysms: systematic review—continuation

2020 ◽  
Vol 25 (S1) ◽  
pp. 12-18
Author(s):  
U. Ronellenfitsch ◽  
K. Meisenbacher ◽  
M. Ante ◽  
M. Grilli ◽  
D. Böckler
Keyword(s):  
Systematic Review ◽  
Endovascular Treatment ◽  
Postoperative Mortality ◽  
High Volume ◽  
Aortic Aneurysms ◽  
Lower Mortality ◽  
Inverse Association ◽  
Case Volume ◽  
Perioperative Mortality ◽  
Low Volume

Abstract Background Many surgical interventions show an inverse association between case volume per hospital/surgeon and perioperative mortality. In the first part of this systematic review it was shown that such an association also exists for the open treatment of infrarenal aortic aneurysms. The second part now examines a possible association with endovascular treatment of infrarenal aortic aneurysms. Objective In a systematic review, the data available on the association between the case volume per hospital/surgeon and perioperative mortality in elective endovascular treatment of infrarenal aortic aneurysms are presented. Materials and Methods Systematic research using defined keywords was carried out. All original works comparing elective endovascular treatment of an infrarenal aortic aneurysm in a “high volume” center with a “low volume” center or by a “high volume” surgeon with a “low volume” surgeon, as defined in each study, were included. Results After deduplication, the literature search produced 1,021 hits. Of these, 16 publications fulfilled the inclusion criteria. With regard to the thresholds for the definition of high volume and low volume, there was marked heterogeneity between individual studies. Twelve of the 15 studies showed a significantly lower mortality in high volume than in low volume centers. The effect measures, usually odds ratios, were between 0.43 and 0.91. In the comparison between high volume and low volume surgeons, there was no difference in mortality in any of the five studies included. Discussion The available data on the association between case volume per hospital and surgeon and the perioperative mortality in elective endovascular treatment of infrarenal aortic aneurysms consistently show that patients operated on in high volume centers have a lower mortality. The volume per surgeon seems to have no influence on perioperative mortality. To achieve the lowest perioperative mortality possible in endovascular treatment of infrarenal aortic aneurysms, centralization with high volume per hospital should be aimed for, taking into consideration the context of the health care system.

scholarly journals Hospital case-volume is associated with case-fatality after aneurysmal subarachnoid hemorrhage

2018 ◽  
Vol 14 (3) ◽  
pp. 282-289 ◽  
Author(s):  
Antti Lindgren ◽  
Sarah Burt ◽  
Ellie Bragan Turner ◽  
Atte Meretoja ◽  
Jin-Moo Lee ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Treatment Modality ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Tertiary Care ◽  
Case Fatality ◽  
High Volume ◽  
Day Case ◽  
Case Volume ◽  
Hospital Case ◽  
Low Volume

Background Inverse association between hospital case-volume and case-fatality has been observed for various nonsurgical interventions and surgical procedures. Aims To study the impact of hospital case-volume on outcome after aneurysmal subarachnoid hemorrhage (aSAH). Methods We included aSAH patients who underwent aneurysm coiling or clipping from tertiary care medical centers across three continents using the Dr Foster Stroke GOAL database 2007–2014. Hospitals were categorized by annual case-volume (low volume: <41/year; intermediate: 41–70/year; high: >70/year). Primary outcome was 14-day in-hospital case-fatality. We calculated proportions, and used multiple logistic regression to adjust for age, sex, differences in comorbidity or disease severity, aneurysm treatment modality, and hospital. Results We included 8525 patients (2363 treated in low volume hospitals, 3563 treated in intermediate volume hospitals, and 2599 in high-volume hospitals). Crude 14-day case-fatality for hospitals with low case-volume was 10.4% (95% confidence interval (CI) 9.2–11.7%), for intermediate volume 7.0% (95% CI 6.2–7.9%; adjusted odds ratio (OR) 0.63 (95%CI 0.47–0.85)) and for high volume 5.4% (95% CI 4.6–6.3%; adjusted OR 0.50 (95% CI 0.33–0.74)). In patients with clipped aneurysms, adjusted OR for 14-day case-fatality was 0.46 (95% CI 0.30–0.71) for hospitals with intermediate case-volume and 0.42 (95% CI 0.25–0.72) with high case-volume. In patients with coiled aneurysms, adjusted OR was 0.77 (95% CI 0.55–1.07) for hospitals with intermediate case-volume and 0.56 (95% CI 0.36–0.87) with high case-volume. Conclusions Even within a subset of large, tertiary care centers, intermediate and high hospital case-volume is associated with lower case-fatality after aSAH regardless of treatment modality, supporting centralization to higher volume centers.

scholarly journals Hospital Case-Volume and Mortality After Ovarian Cancer Surgery: A Population-Based Retrospective Cohort Study

2020 ◽  
Author(s):  
Bo Rim Kim ◽  
Heewon Kim ◽  
Se-gyeong Joo ◽  
Eun Jin Jang ◽  
Junwoo Jo ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
High Volume ◽  
Volume Effect ◽  
Cancer Surgery ◽  
Annual Number ◽  
Case Volume ◽  
Low Volume

Abstract Background: The goal of ovarian cancer surgery has recently shifted from optimal cytoreduction to more complete resection. This study attempted to reassess and update the association between surgical case-volume and both in-hospital and long-term mortality after ovarian cancer surgery using recent data.Methods: Data from all adult patients who underwent ovarian cancer surgery in Korea between 2004 and 2017 were obtained from the database of Korean National Health Insurance Service. Hospitals were categorized by average annual number of surgeries considering overall distribution of case-volume. Postoperative in-hospital and 1, 3, 5-year mortality were analyzed using logistic regression. Results: During the study period, 23,487 ovarian cancer surgeries were performed in 354 hospitals. High-, medium-, and low-volume centers were defined as >100 cases/year, 30-100 cases/year, and <30 cases/year, respectively. In-hospital mortality was significantly higher in medium-volume (1.63%; adjusted odds ratio, 2.28; confidence interval, 1.64-3.17; P <0.001) and low-volume (1.62%; adjusted odds ratio; 2.12; confidence interval, 1.55-2.90; P <0.001) centers compared to high-volume centers (1.13%). In addition, 1-year mortality after ovarian cancer surgery was 6.26%, 7.07%, and 8.06% for high-volume, medium-volume, and low-volume centers, respectively, and the differences among the groups were significant. However, case-volume effect was not apparent in 3- and 5-year mortality after ovarian cancer surgery.Conclusion: Case-volume effect was observed for in-hospital and 1-year mortality after ovarian cancer surgery while no clear association was found between the case-volume and 3- or 5-year mortality.

scholarly journals Hospital case-volume and mortality after ovarian cancer surgery: a population-based retrospective cohort study

2021 ◽  
Author(s):  
Bo Rim Kim ◽  
Heewon Kim ◽  
Se-gyeong Joo ◽  
Eun Jin Jang ◽  
Junwoo Jo ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
High Volume ◽  
Volume Effect ◽  
Cancer Surgery ◽  
Annual Number ◽  
Case Volume ◽  
Low Volume

Abstract Background The goal of ovarian cancer surgery has recently shifted from optimal cytoreduction to more complete resection. This study attempted to reassess and update the association between surgical case-volume and both in-hospital and long-term mortality after ovarian cancer surgery using recent data. Methods Data from all adult patients who underwent ovarian cancer surgery in Korea between 2004 and 2017 were obtained from the database of Korean National Health Insurance Service. Hospitals were categorized by average annual number of surgeries considering overall distribution of case-volume. Postoperative in-hospital and 1, 3, 5-year mortality were analyzed using logistic regression. Results During the study period, 23,487 ovarian cancer surgeries were performed in 354 hospitals. High-, medium-, and low-volume centers were defined as > 100 cases/year, 30–100 cases/year, and < 30 cases/year, respectively. In-hospital mortality was significantly higher in medium-volume (1.63%; adjusted odds ratio, 2.28; confidence interval, 1.64–3.17; P < 0.001) and low-volume (1.62%; adjusted odds ratio; 2.12; confidence interval, 1.55–2.90; P < 0.001) centers compared to high-volume centers (1.13%). In addition, 1-year mortality after ovarian cancer surgery was 6.26%, 7.07%, and 8.06% for high-volume, medium-volume, and low-volume centers, respectively, and the differences among the groups were significant. However, case-volume effect was not apparent in 3- and 5-year mortality after ovarian cancer surgery. Conclusions Case-volume effect was observed for in-hospital and 1-year mortality after ovarian cancer surgery while no clear association was found between the case-volume and 3- or 5-year mortality.

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