MP06-04 IMPACT OF ANESTHESIOLOGY VOLUMES ON EARLY AND LATE OUTCOMES AFTER CYSTECTOMY: A POPULATION-BASED STUDY

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II1 Apr 2016MP06-04 IMPACT OF ANESTHESIOLOGY VOLUMES ON EARLY AND LATE OUTCOMES AFTER CYSTECTOMY: A POPULATION-BASED STUDY D. Robert Siemens, Melanie Jaeger, Xuejiao Wei, and Christopher Booth D. Robert SiemensD. Robert Siemens More articles by this author , Melanie JaegerMelanie Jaeger More articles by this author , Xuejiao WeiXuejiao Wei More articles by this author , and Christopher BoothChristopher Booth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2165AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hospital and surgeon volume are both related to short-term mortality and long term overall survival (OS) and cancer-specific survival (CSS) after radical cystectomy (RC). We hypothesized that anesthesiologist volume would also be related to RC outcomes. In this population-based study, we describe the relationships between hospital, surgeon, and anesthesiologist volumes on early and late outcomes after RC. METHODS Electronic records of treatment and surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients who underwent cystectomy in Ontario, Canada. Volume was divided into quartiles and determined based on mean annual number of hospital/surgeon/anesthesiologist RC cases per 5-year period. Anesthesiologist volume was defined as major colorectal procedures in addition to RC given the similar complexity of these cases. A Cox proportional hazards regression model was used to explore the associations between volume and early and late outcomes. RESULTS The study included 3585 patients with bladder cancer who had RC between 1994-2008. Anesthesiologist RC volumes were surprisingly low over the study period with median annual volume of 1 case (maximum 8.8). The median annual composite anesthesia volume was 9 cases (lowest quartile <6, highest quartile >12); subsequent analyses therefore utilized the composite volume. In unadjusted analysis, anesthesiologist volume was associated with 30 day (lowest volume 27% vs highest volume 21%, p=0.021) and 90 day (lowest volume 39% vs highest volume 31%, p=0.007) readmission rates. These results persisted in multivariate analysis; lower volume anesthesiologists were associated with higher rates of readmission at 30 days (HR 1.40, 95% CI 1.13-1.75) and 90 days (HR 1.40, 95% CI 1.15-1.70). These findings remained significant after adjusting for both surgeon and hospital volumes in the models. In multivariate analysis, anesthesiologist volumes were not associated with postoperative mortality or 5-year OS and CSS. CONCLUSIONS The annual volume of RC for any given anesthesiologist was low, reflecting the lack of sub-specialization in urological procedures in routine clinical practice. Readmission rates after RC are significantly increased with lower volume anesthesia providers. Consideration should be given to consolidating anesthesiology providers to enhance case load for similarly complex urological/general surgical procedures. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e67-e68 Advertisement Copyright & Permissions© 2016MetricsAuthor Information D. Robert Siemens More articles by this author Melanie Jaeger More articles by this author Xuejiao Wei More articles by this author Christopher Booth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...