Bladder Surgery Safer in High-volume Hospitals

NEW YORK (Reuters Health) - Time and again studies have shown that the results of medical procedures are better in hospitals that perform a lot of the operations -- and it holds true when it comes to removing the bladder, according US researchers.

Hospitals that perform many cystectomies -- that is, bladder excisions, usually for cancer -- have significantly fewer patient complications and lower fatality rates than do those with a low volume of such procedures, report Dr. Linda S. Elting and colleagues at the University of Texas M.D. Anderson Cancer Center, Houston.

The researchers examined data from all 133 hospitals in Texas relating to 1302 bladder cancer patients who underwent cystectomy during a 3-year period.

Of the hospitals, 105 performed three or fewer of these procedures per year and were classified as low volume, 23 hospitals did four to 10 annually and were deemed moderate volume, and the remaining 5 performed more than 10 annually and were classified as high volume.

Overall, complications were reported in 12 percent of patients, and 2.2 percent of these patients died, the team reports in the medical journal Cancer.

Mortality was significantly higher in the low-volume hospitals (3.1 percent) than it was in the high-volume hospitals (0.7 percent). Moderate-volume hospitals had an intermediate death rate of 2.9 percent.

After factoring in age and other illnesses, treatment in a high-volume hospital was associated with a 65 percent lower risk of death and a 47 percent lower risk of suffering complications.

The researchers suggest that bladder cancer patients requiring cystectomy seek out centers performing more than 10 cystectomies annually.

However, hospitals with a high ratio of registered nurses to patients also had a lower mortality risk.

"Mortality rates at lower-volume hospitals with high registered nurse-to-patient ratios are very similar to those at high-volume hospitals," Elting told Reuters Health. "These well-staffed hospitals may be a very good alternative for patients who do not have easy access to high-volume hospitals."

SOURCE: Cancer, September 1, 2005.