The connection between selective referrals for radical cystectomy and radical prostatectomy and volume-outcome effects: an instrumental variables analysis

Veerasathpurush Allareddy; Marcia M Ward; George L Wehby; Badrinath R Konety

doi:10.1177/1062860611423728

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The connection between selective referrals for radical cystectomy and radical prostatectomy and volume-outcome effects: an instrumental variables analysis

Journal article

Peer reviewed

The connection between selective referrals for radical cystectomy and radical prostatectomy and volume-outcome effects: an instrumental variables analysis

Veerasathpurush Allareddy, Marcia M Ward, George L Wehby and Badrinath R Konety

American journal of medical quality, Vol.27(5), pp.434-440

09/2012

DOI: 10.1177/1062860611423728

PMID: 22205768

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Abstract

This study delineates the roles of "selective referrals" and "practice makes perfect" in the hospital procedure volume and in-hospital mortality association for radical cystectomy and radical prostatectomy. This is a retrospective analysis of the Nationwide Inpatient Sample (years 2000-2004). All hospitalizations with primary procedure codes for radical cystectomy and radical prostatectomy were selected. The association between hospital procedure volume and in-hospital mortality was examined using generalized estimating equations and by instrumental variables approaches. There was an inverse association between hospital procedure volume and in-hospital mortality for radical cystectomy (odds ratio = 0.57; 95% confidence interval = 0.38-0.87; P < .05). Results from the 2-stages least squares regression approach suggested that receiving treatment in high-volume hospitals decreased the probability of in-hospital mortality by 0.02 points, compared with 0.01 points using the ordinary least squares regression approach. Outcomes following radical cystectomy appear to be driven by "practice makes perfect."

Cystectomy - mortality

Multivariate Analysis

Cystectomy - utilization

Hospital Mortality

Outcome Assessment (Health Care)

Humans

Middle Aged

Male

Regression Analysis

Prostatectomy - utilization

Female

Aged

Hospitals, High-Volume - statistics & numerical data

Referral and Consultation

Prostatectomy - mortality

Details

Title: Subtitle: The connection between selective referrals for radical cystectomy and radical prostatectomy and volume-outcome effects: an instrumental variables analysis
Creators: Veerasathpurush Allareddy - Harvard School of Dental Medicine, Boston, MA 02115, USA. VA15@hsdm.harvard.edu
Marcia M Ward
George L Wehby
Badrinath R Konety
Resource Type: Journal article
Publication Details: American journal of medical quality, Vol.27(5), pp.434-440
Publisher: United States
DOI: 10.1177/1062860611423728
PMID: 22205768
ISSN: 1062-8606
eISSN: 1555-824X
Language: English
Date published: 09/2012
Academic Unit: Preventive and Community Dentistry; Health Management and Policy; Economics; Public Policy Center (Archive)
Record Identifier: 9984063130302771

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