Practice makes perfect in cancer surgery

Researchers determine higher hospital and surgeon volume lead to better outcomes when treating bladder cancer patients

In a new, in-depth research project, Queen’s professors Rob Siemens (Urology) and Christopher Booth (Cancer Care and Epidemiology) investigated what affect higher volume hospitals and surgeons had on the outcomes of patients undergoing a radical cystectomy for bladder cancer in Ontario.

Using data provided by the Institute for Clinical Evaluative Sciences (ICES) the investigators studied 2,802 patients who underwent the procedure between 1994 and 2008 in Ontario and found that higher volume hospital and surgeons were associated with less post-operative complications and better overall survival.

These results are intriguing and will undoubtedly lead to some controversy in their interpretation,” says Dr. Siemens. “We wondered if the processes and interactions that lead to better outcomes for patients treated by higher volume providers can be studied and identified, perhaps leading to improved outcomes for all if adopted by lower volume hospitals and surgeons.

The recent study explored a number of different aspects of bladder cancer care to better understand how quality surgical care is delivered for patients with advanced bladder cancer. The explanations for this volume-outcome relationship still remain mostly unidentified which could be a research project in the future.

This research has only been able to illuminate a small fraction of the factors that explain the improved outcomes of higher volume providers,” says Dr. Siemens. “Some would interpret this as a call to more aggressively support a policy of centralizing care at higher volume hospitals for complex medical/surgical diseases.

Siemens et al., (2014). Processes of Care and the Impact of Surgical Volumes on Cancer-specific Survival: A Population-based Study in Bladder Cancer. Urology, 84: 1049–1057 [Abstract]

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