Where are we with improving outcome guidance? An update on pelvic urological services in the NHS

Abstract

Background: The volume–outcome relationship in surgery has been a focus of interest for over a decade. The National Institute for Health and Care Excellence (NICE) published their improving outcome guidance in 2002, which encouraged a regionalised multidisciplinary approach in managing urological cancer cases and recommended centralisation of urological pelvic surgery. The current study offers an updated view on the urological pelvic services in England with regard to radical cystectomy (RC) and radical prostatectomy (RP) and adherence to improving outcome guidance guidelines and patterns of services provision since its introduction in 2002. Methods: The data for inpatient elective RC and RP were taken from hospital episodes statistics for 2003–2013. The RC and RP cases were calculated separately per year for every trust to calculate the annual rates and then combined for every trust. The catchment areas for RC and RP were calculated using the proportionate-flow method. Results: The number of trusts performing RC and RP reduced significantly over the 10 years, while in the same period, the numbers of RC and RP performed increased significantly ( P<0.05). There has been a steady increase in the cases referred to another trust for their RC or RP surgery ( P<0.05). Overall, there has been a significant increase in the number of trusts achieving the improving outcome guidance recommended minimal case volume of 50 or more (RC + RP combined) over the 10-year analysis ( P=0.0006). Conclusion: There has been a shift in urological pelvic surgery provision in England since the publication of improving outcome guidance by NICE in 2002, with over 95% of cases being performed in improving outcome guidance compliant centres achieving 50 cases or more per year. Simultaneously, a significant reduction in postoperative mortality and the hospital length of stay has been seen over this period.