Mortality after major surgery for urologic cancers in specialized urology hospitals: are they any better?

PURPOSE Specialty-specific hospitals and hospitals with a high volume of complex procedures have been shown to have better outcomes. We sought to determine whether a high volume of unrelated complex procedures or procedures in the same specialty area (urology) could translate into better outcomes after major urologic cancer surgery. METHODS We performed a cross-sectional analysis of administrative discharge abstract data from the Nationwide Inpatient Sample of the Health Care Utilization Project for years 1998 to 2002. Comparison of outcome after three major urologic cancer-related surgical procedures (radical cystectomy [RC], radical nephrectomy [RN], and radical prostatectomy [RP]) at hospitals by procedure-specific volume, specialized urology status, and Leapfrog criteria was obtained to determine in-hospital mortality after the procedure. All patients in the database with a diagnosis of bladder, kidney, or prostate cancer being admitted for RC, RN, or RP between 1998 and 2002 were included. RESULTS Neither specialized urology status nor meeting Leapfrog volume criteria for unrelated procedures was associated with lower odds of in-hospital mortality after any of the procedures examined. High-volume hospitals (for RC and RP) and moderate-volume hospitals (for RP) were associated with lower odds of mortality. None of the examined hospital volume-related factors was associated with lower odds of mortality after RN. CONCLUSION In-hospital mortality after two of three major urologic cancer procedures is affected only by procedure-specific volumes. Generalized process measures existing in hospitals performing a high volume of general urologic procedures or unrelated complex procedures may be less important determinants of procedure-specific outcomes in patients.