The following is a summary of “Disparities in access to high-volume centers and in hospital discharge status following radical cystectomy in Florida,” published in the June 2023 issue of the Urologic Oncology by Baird et al.
Radical cystectomy (RC) centralization enhances outcomes but may unintentionally exacerbate existing disparities in care. Researchers aimed to evaluate differences in access to high-volume RC centers and postoperative recovery. They identified RC patients from 2013 to 2019 in the Florida Inpatient Data File. Using data-derived 75th and 90th quantiles, hospital annual cystectomy volume was categorized as low, medium, or high: <5, 5 to 13, and >13 RC/year.
In a low-volume hospital, outcomes included inpatient mortality, non-home discharge, in-hospital complications, length of stay (LOS), and surgery. Utilized were mixed-effects regression models that accounted for clustering within centers. RC at a high-volume center was associated with lower odds of mortality, non-home discharge, shorter duration of stay, and fewer complications (all P≤0.001) among 4,396 patients treated at 105 centers. Black race (OR 1.67, 95% CI 1.142.39), Hispanic/Latino ethnicity (OR 1.74, 95% CI 1.322.00), and residing in the northeast (OR 2.11, 95% CI 1.582.80) or west Florida (OR 1.34, 95% CI 1.101.71) were associated with receiving care in a low-volume hospital.
Black patients had increased odds of non-home discharge (OR 1.91, 95% CI 1.272.86) and prolonged LOS (IRR 1.17, 95% CI 1.071.27) but no difference in postoperative complications (P > 0.2). In Florida, they observed racial and geographic disparities in the likelihood of undergoing RC at a high-volume hospital, as well as longer LOS and lower odds of home discharge among Black patients, despite comparable rates of complications. Increasing access to high-quality RC care for these vulnerable populations is necessary.