Between-surgeon variation in 90-day mortality after radical cystectomy for bladder cancer.

Abstract

512 Background: Radical cystectomy for bladder cancer is a complex surgical oncology procedure. Given the high degree of skill required to perform radical cystectomy, it is plausible that outcomes may vary among surgeons. We determined whether between-surgeon variation, known as heterogeneity, exists for urologic surgeons practicing at a Canadian academic center. Methods: A retrospective analysis of data from the University of Alberta (UA) Radical Cystectomy Database was performed. Between September 1994 and August 2017, 1031 consecutive patients underwent curative-intent radical cystectomy for histologically proven urothelial carcinoma of the bladder (cTanyN1-3M0) by 1 of 11 urologic surgeons. The main outcome measure was 90-day mortality rate. Multivariable models were used to evaluate heterogeneity in 90-day mortality rate after adjustment for case mix. Statistical tests were two-sided (p≤0.05). Results: Data were evaluable for 1031 patients. There was between-surgeon variation in the 90-day mortality rate (unadjusted range, 0.9% to 13.1%). 3 surgeons had 90-day mortality rates ≤ 3% whereas 5 surgeons had 90-day mortality rates ≥ 5%. Conclusions: A patient’s likelihood of achieving an optimal perioperative outcome differs depending on which urologic surgeon performs his/her radical cystectomy. Research examining the mechanism (s) underlying surgical heterogeneity in perioperative outcome after radical cystectomy is needed.