Login to Access Video or Poster Abstract: MP54-10
Sources of Funding: none

Introduction

OBJECTIVE: To examine the national patterns of quality indicators for cystectomy and identify facility characteristics predictive of high quality care.

Methods

METHODS: We performed a retrospective cohort study of patients who underwent cystectomy for cT2-cT4, N0 bladder cancer between 2008 and 2013 using the National Cancer Database. Quality indicators were defined as 1) surgical margin status, 2) lymph node yield, and 3) receipt of neoadjuvant chemotherapy. Univariate analysis and multivariate analysis was used to assess the relationship between academic facility type and annual cystectomy volume and quality indicators while controlling for demographic and pathologic characteristics.

Results

RESULTS: A total of 12,083 patients met our inclusion criteria. On multivariate analysis, while controlling for demographic and pathologic characteristics, treatment at academic facilities was associated with higher rates of negative margins (OR: 0.80; 95%CI: [0.67-0.95], p=0.01), greater lymph node yields (OR: 0.49; [0.44-0.55], p<0.001), and higher rates of neoadjuvant chemotherapy(OR: 0.73; [0.64-0.55], p<0.001). High volume facilities (>24 cystectomies/year) were associated with greater lymph node yields (OR: 2.69; [2.08-3.47], p<0.001), but not significantly associated with increased neoadjuvant chemotherapy use. Intermediate volume centers (12-24 cystectomies/year) were associated with increased neoadjuvant chemotherapy use (OR: 1.60; [1.36-1.88], p<0.001).

Conclusions

CONCLUSIONS: At a national level, high quality indicators of cystectomy (negative surgical margin, adequate lymph node yields, and receipt of neoadjuvant chemotherapy) were more likely to occur at academic facilities. High volume centers were associated with higher lymph node yields. Such data support the regionalization of cystectomy care to these centers.

Funding

none