Minimum Volume Standards: An Incentive To Perform More Radical Cystectomies?

Area of Science:

• Urology
• Health Services Research
• Oncology

Background:

• Minimum volume standards (MVS) for surgical procedures are debated, with concerns about potential negative impacts like increased surgery rates.
• Opponents fear MVS may create an incentive for surgeons to perform unnecessary procedures.

Purpose of the Study:

• To assess if implementing MVS for radical cystectomy (RC) in the Netherlands led to more RCs performed outside guideline-recommended indications.
• To investigate potential iatrogenic effects of MVS on surgical practice.

Main Methods:

• Analysis of all RCs for bladder cancer in the Netherlands Cancer Registry (2006-2017).
• Comparison of RCs in intermediate- and high-volume hospitals before and after sequential MVS implementation.
• Descriptive analyses to identify shifts in disease stage indications and seasonal variations in procedure volume.

Main Results:

• No significant shift towards performing RCs for disease stages outside recommended indications was observed post-MVS implementation.
• Similar outcomes were noted for both intermediate- and high-volume hospitals.
• No increase in RCs performed towards the end of the year was detected.

Conclusions:

• The introduction of MVS for RC in the Netherlands did not result in an unwanted incentive to perform more procedures.
• The findings support the implementation of MVS as a measure to ensure appropriate surgical care.