Disparities in access to high-volume centers and in hospital discharge status following radical cystectomy in Florida

• Published in: Urologic oncology 2023-06, Vol.41 (6), p.294.e19-294.e26
• Main Authors: Baird, Bryce A., Taylor, Tiara, Brennan, Emily, Borkar, Shamali, Anderson, Augustus, Boorjian, Stephen A., Zganjar, Andrew, Colibaseanu, Dorin T., Spaulding, Aaron C., Lyon, Timothy D.
• Format: Article
• Language: English
• Subjects: Bladder cancer; Cystectomy - adverse effects; Florida - epidemiology; Health services research; Hospitals, High-Volume; Hospitals, Low-Volume; Humans; Length of Stay; Patient Discharge; Postoperative Complications - etiology; Radical cystectomy; Urinary Bladder Neoplasms - surgery
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2022.11.007

•Examined radical cystectomy (RC) patients treated in Florida 2013 to 2019•RC at a high-volume center associated with improved perioperative outcomes•Black and Hispanic patients were more likely to undergo RC at a low-volume hospital•Black patients had longer length of stay and less likely to discharge home after RC•Further work is needed to address these racial disparities in post-RC outcomes Centralization of radical cystectomy (RC) improves outcomes but may unintentionally exacerbate existing disparities in care. Our objective was to assess disparities in access to high-volume RC centers and in postoperative recovery. We identified RC patients in the Florida Inpatient Data File from 2013 to 2019. Hospital annual cystectomy volume was categorized as low, medium, or high using data-derived 75th and 90th quantiles: 13 RC/year. Outcomes included inpatient mortality, non-home discharge, in-hospital complications, length of stay (LOS) and surgery in a low-volume hospital. Mixed-effects regression models accounting for clustering within centers were utilized. Among 4,396 patients treated at 105 centers, RC at a high-volume center was associated with lower odds of mortality, non-home discharge, shorter length of stay and fewer complications (all P ≤ 0.001). Characteristics associated with receiving care in a low-volume hospital included Black race (OR 1.67, 95% CI 1.14−2.39), Hispanic/Latino ethnicity (OR 1.74, 95% CI 1.32−2.00), and residing in northeast (OR 2.11, 95% CI 1.58−2.80) or west Florida (OR 1.34, 95% CI 1.05−1.71). Black patients had increased odds of non-home discharge (OR 1.91, 95% CI 1.27−2.86) and longer LOS (IRR 1.17, 95% CI 1.08−1.27), but no difference in the rate or number of postoperative complications (P > 0.2). In Florida, we observed racial and geographic disparities in likelihood of undergoing RC at a high-volume hospital, and that Black patients experienced longer LOS and lower odds of home discharge despite similar rates of complications. Efforts to increase access to high-value RC care for these vulnerable populations are needed.