Clear survival benefit for patients who have high-risk cancer surgeries at hospitals that commonly perform the procedures

Choosing a hospital that either performs many cystectomies - the surgical removal of the urinary bladder - or has a high nurse-to-patient ratio minimizes post-operative complications after the procedure, according to a new study.

The report, published in the September 1, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society, indicates that post-operative mortality and complications were reduced by up to 75 percent in the best-case scenarios.

This year more than 63,000 Americans will get bladder cancer, with over 20 percent becoming invasive, leading to more than 13,000 deaths. The standard of care for invasive bladder cancer is cystectomy, which itself is associated with a mortality rate of about 2 percent, making it what doctors consider a moderate-risk surgery.

Studies show a clear survival benefit for patients who have high-risk cancer surgeries at hospitals that commonly perform the procedures. However, most cancer-related surgeries are moderate risk. In this category, studies analyzing the benefit of choosing a high procedure volume hospital have had inconsistent results.

Led by Linda S. Elting, Dr.P.H., of the University of Texas M. D. Anderson Cancer Center in Houston, researchers investigated the relationship between hospitals' procedure volume and their post-operative mortality and morbidity. Researchers also analyzed data for hospital-related risk factors to help explain this relationship.

The investigators collected and analyzed data from 1302 bladder cancer patient who underwent cystectomy at 133 hospitals in Texas. They found about one in eights patients (12 percent) had post-operative complications and about one in 45 (2.2 percent) died. But hospitals performing over 10 cystectomies per year had statistically significant lower mortality and morbidity rates. Mortality was reduced by almost 75 percent and complications were reduced by approximately 50 percent at the high-volume hospitals. Interestingly, hospitals with a high nurse-to-patient ratio reduced post-operative mortality by more than 50 percent regardless of the hospital's cystectomy volume.

"Referral to a hospital performing [more than] 10 cystectomies annually is indicated for patients who have access to high-volume centers," conclude the authors. They add that "among patients who do not have access to high-volume hospitals, treatment in a local hospital with a high nurse-to-patient ratio may confer a similar benefit."