For Complex Bladder Cancer Surgery, Brady Patients Do Better
There’s a lot to be said for a “highvolume” center — a hospital, usually a teaching institution, that treats many people who have the same condition every year. High-volume centers perform certain complex procedures so often that not only are the surgeons highly experienced at doing them, but the nurses and clinical staff who care for these patients are expert at attending to their specific needs.
Urologists at Johns Hopkins offer a number of treatment options for people with bladder cancer, including minimally invasive approaches such as roboticassisted laparoscopic radical cystoprostatectomy, and open surgery. Trinity Bivalacqua, M.D., Ph.D., Director of Urologic Oncology, and urologists including Phil Pierorazio, M.D., and Christian Pavlovich, M.D., perform more than 100 radical cystectomy procedures a year. They also offer all types of incontinent and continent urinary diversions. “What they have found is that more experience is crucial for optimal and superior oncological and functional results,” says Bivalacqua.
Recently, a team of Hopkins scientists looked at the impact of hospital volume on the outcomes of patients who underwent a partial or radical cystectomy as treatment for their advanced bladder cancer. “Historically, these procedures have been associated with a high r ate of complications,” says Bivalacqua, who led the team.
Having surgery at Johns Hopkins, the highest-volume center in the state, was associated with decreased length of ICU stays, fewer in-hospital deaths and lower hospital fees.
Partial cystectomy: Urologist Max Kates, M.D., investigated complications associated with partial cystectomy using the Nationwide Inpatient Sample database. Most notably, he and colleagues found that for each additional partial cystectomy a hospital performed, the risk of in-hospital death decreased by 30 percent. They also showed that increased hospital volume was independently associated with decreased deaths in bladder cancer patients undergoing partial cystectomy. This work was published in Urologic Oncology.
Radical cystectomy: In a similar study, urologist Michael Gorin, M.D. investigated the outcomes of radical cystectomy in the state of Maryland. He and co-investigators found that having surgery at Johns Hopkins, the highest-volume center in the state, was associated with decreased length of ICU stays, fewer in-hospital deaths and lower hospital fees. “These data are in line with observations from other large studies,” says Bivalacqua. Unique to this report, after controlling for differences in the medical complexity of treated patients, the authors showed that having a radical cystectomy at Johns Hopkins resulted in improved outcomes and reduced costs. This study was published in the Canadian Journal of Urology. “Combined, these two reports argue strongly in favor of performing complex bladder cancer surgery at high-volume centers of excellence such as Johns Hopkins.”