Impact of hospital provider volume on outcome for radical urological cancer surgery in England

Urol Int. 2010;85(1):11-5. doi: 10.1159/000318631. Epub 2010 Jul 8.


Introduction: Complex surgical procedures are associated with higher mortality and morbidity. There is a paucity of data supporting a volume-outcome relationship in the United Kingdom. We analysed Hospital Episode Statistics (HES) to contemplate the association of hospital provider volume and short-term outcomes (mortality rate and hospital stay) for 3 radical urological procedures in England.

Materials and methods: The HES database was extracted for radical prostatectomy (RP), radical cystectomy (RC) and radical nephrectomy (RN) using ICD-10 and OPCS-4 codes for 7 years. Hospitals were divided into quartiles depending on the annual hospital volume. The impact of hospital provider volume was analysed for outcomes.

Results: Overall 43,946 patients were included in the study. RP patients had the lowest mortality rate (0.2%) and shorter in-patient stay (7 days). Mortality from RC and RN were 475 (5.3%) and 537 (2.6%), respectively. There was no significant difference for mortality following RP in four volume groups (p = 0.76). The mortality rate for RC decreased from 6.9% in the very low-volume group to 4.1% in the high-volume group (p < 0.001) without change in the in-hospital stay. The proportion of patients treated at high-volume centres for RP, RC and RN has increased from 0 to 42, 22 to 35 and 10 to 38%, respectively, over a 7-year study period.

Conclusion: In England, hospital provider volume has a significant impact on outcome measures for radical pelvic urological procedures with a lower mortality (RC) and shorter in-patient stay (RP). Thus HES data from England support the hospital volume-outcome relationship and emphasise the centralisation of care for radical urological procedures.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Chi-Square Distribution
  • Cystectomy / statistics & numerical data
  • Databases as Topic
  • England
  • Female
  • Hospital Mortality
  • Hospitals / statistics & numerical data*
  • Humans
  • Length of Stay
  • Logistic Models
  • Male
  • Middle Aged
  • Nephrectomy / statistics & numerical data
  • Outcome and Process Assessment, Health Care / statistics & numerical data*
  • Prostatectomy / statistics & numerical data
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Urologic Neoplasms / mortality
  • Urologic Neoplasms / surgery*
  • Urologic Surgical Procedures / adverse effects
  • Urologic Surgical Procedures / mortality
  • Urologic Surgical Procedures / statistics & numerical data*