The Connection Between Selective Referrals for Radical Cystectomy and Radical Prostatectomy and Volume–Outcome Effects

Abstract

This study delineates the roles of "selective referrals" and "practice makes perfect" in the hospital procedure volume and in-hospital mortality association for radical cystectomy and radical prostatectomy. This is a retrospective analysis of the Nationwide Inpatient Sample (years 2000-2004). All hospitalizations with primary procedure codes for radical cystectomy and radical prostatectomy were selected. The association between hospital procedure volume and in-hospital mortality was examined using generalized estimating equations and by instrumental variables approaches. There was an inverse association between hospital procedure volume and in-hospital mortality for radical cystectomy (odds ratio = 0.57; 95% confidence interval = 0.38-0.87; P < .05). Results from the 2-stages least squares regression approach suggested that receiving treatment in high-volume hospitals decreased the probability of in-hospital mortality by 0.02 points, compared with 0.01 points using the ordinary least squares regression approach. Outcomes following radical cystectomy appear to be driven by "practice makes perfect."

Who Does Not Receive Treatment for Cancer?

“…11 Newer US Food and Drug Administrationapproved treatments that are better tolerated and more easily administered (eg, oral medications for kidney cancers) might be expected to reduce treatment refusal, but the ICR data over the 2004 to 2010 period showed no decrease in nontreatment rates over the time during which these newer treatments were introduced. 21 Patients with cancer who definitely want treatment choices are likely to seek out accredited, high-volume facilities that offer more comprehensive services. Other patient characteristics related to nontreatment also emerged.…”

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

“…The volume-outcome relationship is hypothesized to be driven by one of two mechanisms: "selective referral" or "practice makes perfect" (38). Hospital ECMO volume may increase through selective referral to hospitals reputed to have favorable ECMO outcomes (1,39).…”

The Volume–Outcome Relationship Revisited: Practice Indeed Makes Perfect

“…; Allareddy et al. ) and geographical factors (Seider, Gaynor, and Vogt ; Tsai et al. ; Barker, Rosenthal, and Cram ).…”

“…Only a few studies use instrumental variables (IV) regression or simultaneous equation models to overcome endogeneity. Common instruments are the number of hospital beds (Luft, Hunt, and Maerki 1987;Farley and Ozminkowski 1992;Norton et al 1998;Allareddy et al 2012) and geographical factors (Seider, Gaynor, and Vogt 2004;Tsai et al 2006;Barker, Rosenthal, and Cram 2011). However, the number of hospital beds, and hence the size of a hospital, has been shown to influence quality directly (Keeler et al 1992); that is, larger hospitals tend to be of better quality.…”