Is the Complication Rate of Radical Cystectomy Predictive of the Complication Rate of Other Urological Procedures? Vincent Fradet,* Veerasathpurush Allareddy, David S. Aaronson and Badrinath R. Konety From the Departments of Urology and Epidemiology, University of California-San Francisco, San Francisco, California, and Department of Epidemiology, Iowa University (VA), Iowa City, Iowa Abbreviations and Acronyms HCUP  Healthcare Cost and Utilization Project NIS  Nationwide Inpatient Sample Submitted for publication July 23, 2008. Supported by a Laval University McLaughlin Dean’s Grant (VF). * Correspondence: Department of Urology, University of California-San Francisco, Box 1695, 1600 Divisadero St., San Francisco, California 94143 (telephone: 415-885-3679; FAX: 415-885- 7443; e-mail: fradetv@urology.ucsf.edu). For another article on a related topic see page 1387. Purpose: While there is a large body of evidence supporting the procedure volume-outcome relationship for surgical therapy for bladder cancer, to our knowledge it is not known whether expertise with this surgery can predict better quality of care for other urological procedures. We hypothesized that the hospital volume of radical cystectomy is an important predictor of complications of other urological procedures. Material and Methods: We explored data from the Health Care Utilization Project Nationwide Inpatient Sample. All patients who underwent any common urological procedure as the primary procedure were selected for analysis. Any complication was the outcome variable of interest, whereas radical cystectomy hospital volume was the independent variable of interest. Logistic regression models were fitted using the generalized estimating equations method to adjust for the effects of clustering of similar outcomes within hospitals. The covariates were patient age, gender, procedure type, comorbidities and pro- cedure year. Results: We observed a dose-response type of relationship for 2 urological oncol- ogy procedures. Compared to hospitals where a high volume of radical cystecto- mies was performed hospitals where cystectomy was not performed were associ- ated with a higher risk of complications after nephrectomy and radical prostatectomy (OR 1.16, p  0.02 and OR 1.49, p 0.001, respectively). This was not seen for the other general or subspecialized urological procedures examined. Conclusions: A higher hospital radical cystectomy volume appears to lead to a lower risk of complications only after other common urological oncological proce- dures, namely radical prostatectomy and nephrectomy, but not after nononco- logical urology procedures. Key Words: bladder, cystectomy, urological surgical procedures, complications, outcome assessment (health care) THERE is a large body of evidence sup- porting the volume-outcome relation- ship for surgical therapy for bladder cancer. This observation has been confirmed in various single institu- tion and population based data sets. Prior analysis of HCUP NIS data has also demonstrated that surgeon vol- ume has a significant impact on in- hospital mortality and length of stay after surgery. 1 Radical cystectomy tends to be regionalized at urban high volume centers 2 but there still are im- portant disparities in its use in vul- nerable patients. 3 Examination of the University Health System Consor- tium Clinical Database demonstrated that even among academic medical 1054 www.jurology.com 0022-5347/09/1813-1054/0 Vol. 181, 1054-1060, March 2009 THE JOURNAL OF UROLOGY ® Printed in U.S.A. Copyright © 2009 by AMERICAN UROLOGICAL ASSOCIATION DOI:10.1016/j.juro.2008.11.016