Determinants of radical cystectomy operative time

To examine factors associated with radical cystectomy operative time among Medicare beneficiaries.

Using linked Surveillance, Epidemiology, and End Results-Medicare data, we identified 4,975 patients who underwent a radical cystectomy during 1991 to 2007. Using a validated method of using anesthesia administrative data to quantify operative time, we used generalized estimating equations to examine the association of patient, provider, and hospital factors on radical cystectomy operative time.

We found that mean operative time decreased by 5 minutes per year (Δ = -5.3min/y, P<0.001). Longer operative times were found in academic centers (Δ =+39.0min vs. nonacademic), continent diversion (Δ =+34.9min vs. ileal conduit), surgical excision of≥11 lymph nodes (Δ =+24.9min vs. 1-5), female (Δ =+32.3min vs. male sex), and perioperative anesthesia procedures such as placement of central venous catheters or arterial lines (Δ =+47.2min vs. no procedures), respectively (all P<0.01). In adjusted analysis, higher surgeon volume (Δ =-22.0min vs. lowest volume) was associated with shorter operative times (P = 0.002).

Operative times for cystectomy have been steadily decreasing annually. There is notable variation based on academic affiliation, diversion type and extent of lymphadenectomy, surgeon and hospital volumes, as well as use of anesthetic procedures. Efforts to improve operative time by selective referral to high-volume surgeons or hospitals or both, or judicious use of perioperative procedures may have a positive effect on health care costs and overall quality of care for patients undergoing radical cystectomy for bladder cancer.