Centralization and Quality Control of Elective Surgery Improve Outcome: Aren’t We Ethically Obliged to Force the Pace of Creating High-volume Centers?

Tilki, Derya; Huland, Hartwig; Graefen, Markus

doi:10.1016/j.eururo.2015.03.032

Cited by 16 publications

(11 citation statements)

References 11 publications

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“…In light of the persistent association between improved surgical oncology outcomes and higher‐volume experience, the centralization of high‐risk cancer surgery has been proposed . Our results demonstrate that a volume‐outcome relationship exists for RPS.…”

Section: Discussionmentioning

confidence: 61%

“…In light of the persistent association between improved surgical oncology outcomes and higher-volume experience, the centralization of high-risk cancer surgery has been proposed. [24][25][26] Our results demonstrate that a volume-outcome relationship exists for RPS. In theory, centralization may improve outcomes for RPS; however, there is a risk that centralization would limit access to care for some patients, including minorities or those who live far from high-volume centers.…”

Section: Discussionmentioning

confidence: 66%

See 1 more Smart Citation

Predictors of surgical quality for retroperitoneal sarcoma: Volume matters

Maurice

Yih

Ammori

et al. 2017

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 66%

Predictors of surgical quality for retroperitoneal sarcoma: Volume matters

Maurice

Yih

Ammori

et al. 2017

Journal of Surgical Oncology

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“…This also prevented an assessment of the impact of bladder cuff management on oncological outcomes in each subgroup. None of the included series accounted for surgeon and hospital volume, which may be regarded as a shortcoming, as these two parameters have been shown to impact oncological outcomes of numerous surgical procedures [64].…”

Section: Discussionmentioning

confidence: 99%

Oncological Outcomes of Laparoscopic Nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: An European Association of Urology Guidelines Systematic Review

Peyronnet

Seisen

Dominguez-Escrig

et al. 2019

European Urology Focus

122

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“…From an economic perspective, RARP has proven more expensive than laparoscopic (LRP) and open RP (ORP) because of the cost of the capital purchase, maintenance and consumables associated with it ; however, various health technology assessments (HTAs) have shown that costs can be significantly reduced by increases in surgical volume , and indeed there is a push towards centralization for RP from a quality perspective, regardless of surgical approach . In the UK, the NHS National Institute for Health and Care Excellence guidelines recommend that at least 150 RARPs are performed per year to maintain the economic viability of a robotic programme .…”

Section: Introductionmentioning

confidence: 99%

Patterns‐of‐care and health economic analysis of robot‐assisted radical prostatectomy in the Australian public health system

et al. 2015

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ObjectivesTo compare patterns of care and peri-operative outcomes of robot-assisted radical prostatectomy (RARP) with other surgical approaches, and to create an economic model to assess the viability of RARP in the public case-mix funding system. Patients and MethodsWe retrospectively reviewed all radical prostatectomies (RPs) performed for localized prostate cancer in Victoria, Australia, from the Victorian Admitted Episode Dataset, a large administrative database that records all hospital inpatient episodes in Victoria. The first database, covering the period from July 2010 to April 2013 (n = 5 130), was used to compare length of hospital stay (LOS) and blood transfusion rates between surgical approaches. This was subsequently integrated into an economic model. A second database (n = 5 581) was extracted to cover the period between July 2010 and June 2013, three full financial years, to depict patterns of care and make future predictions for the 2014-2015 financial year, and to perform a hospital volume analysis. We then created an economic model to evaluate the incremental cost of RARP vs open RP (ORP) and laparoscopic RP (LRP), incorporating the cost-offset from differences in LOS and blood transfusion rate. The economic model constructs estimates of the diagnosis-related group (DRG) costs of ORP and LRP, adds the gross cost of the surgical robot (capital, consumables, maintenance and repairs), and manipulates these DRG costs to obtain a DRG cost per day, which can be used to estimate the cost-offset associated with RARP in comparison with ORP and LRP. Economic modelling was performed around a base-case scenario, assuming a 7-year robot lifespan and 124 RARPs performed per financial year. One-and two-way sensitivity analyses were performed for the four-arm da Vinci SHD, Si and Si dual surgical systems (Intuitive Surgical Ltd, Sunnyvale, CA, USA). ResultsWe identified 5 581 patients who underwent RP in 20 hospitals in Victoria with an open, laparoscopic or robotassisted surgical approach in the public and private sector. The majority of RPs (4 233, 75.8%), in Victoria were performed in the private sector, with an overall 11.5% decrease in the total number of RPs performed over the 3-year study period. In the most recent financial year, 820 (47%), 765 (44%) and 173 patients (10%) underwent RARP, ORP and LRP, respectively. In the same timeframe, RARP accounted for 26 and 53% of all RPs in the public and private sector, respectively. Public hospitals in Victoria perform a median number of 14 RPs per year and 40% of hospitals perform <10 RPs per year. In the public system, RARP was associated with a mean (AESD) LOS of 1.4 (AE1.3) days compared with 3.6 (AE2.7) days for LRP and 4.8 (AE3.5) days for ORP (P < 0.001). The mean blood transfusion rates were 0, 6 and 15% for RARP, LRP and ORP, respectively (P < 0.001). The incremental cost per RARP case compared with ORP and LRP was A$442 and A$2 092, respectively, for the da Vinci S model, A$1 933 and A$3 583, respectively, for the da Vinci Si model and A$3 548 and A$...

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Centralization and Quality Control of Elective Surgery Improve Outcome: Aren’t We Ethically Obliged to Force the Pace of Creating High-volume Centers?

Cited by 16 publications

References 11 publications

Predictors of surgical quality for retroperitoneal sarcoma: Volume matters

Predictors of surgical quality for retroperitoneal sarcoma: Volume matters

Oncological Outcomes of Laparoscopic Nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: An European Association of Urology Guidelines Systematic Review

Patterns‐of‐care and health economic analysis of robot‐assisted radical prostatectomy in the Australian public health system

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