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Influence of hospital volume on nephrectomy mortality and complications: a systematic review and meta-analysis stratified by surgical type

Overview of attention for article published in BMJ Open, September 2017
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Title
Influence of hospital volume on nephrectomy mortality and complications: a systematic review and meta-analysis stratified by surgical type
Published in
BMJ Open, September 2017
DOI 10.1136/bmjopen-2017-016833
Pubmed ID
Authors

Ray C J Hsu, Theodosia Salika, Jonathan Maw, Georgios Lyratzopoulos, Vincent J Gnanapragasam, James N Armitage

Abstract

The provision of complex surgery is increasingly centralised to high-volume (HV) specialist hospitals. Evidence to support nephrectomy centralisation however has been inconsistent. We conducted a systematic review and meta-analysis to determine the association between hospital case volumes and perioperative outcomes in radical nephrectomy, partial nephrectomy and nephrectomy with venous thrombectomy. Medline, Embase and the Cochrane Library were searched for relevant studies published between 1990 and 2016. Pooled effect estimates for nephrectomy mortality and complications were calculated for each nephrectomy type using the DerSimonian and Laird random-effects model. Sensitivity analyses were performed to examine the effects of heterogeneity on the pooled effect estimates by excluding studies with the heaviest weighting, lowest methodological score and most likely to introduce bias from misclassification of standardised hospital volume. Some 226 372 patients from 16 publications were included in our review and meta-analysis. Considerable between-study heterogeneity was noted and only a few reported volume-outcome relationships specifically in partial nephrectomy or nephrectomy with venous thrombectomy.HV hospitals were correlated with a 26% and 52% reduction in mortality for radical nephrectomy (OR 0.74, 95% CI 0.61 to 0.90, p<0.01) and nephrectomy with venous thrombectomy (OR 0.48, 95% CI 0.29 to 0.81, p<0.01), respectively. In addition, radical nephrectomy in HV hospitals was associated with an 18% reduction in complications (OR 0.82, 95% CI 0.73 to 0.92, p<0.01). No significant volume-outcome relationship in mortality (OR 0.84, 95% CI 0.31 to 2.26, p=0.73) or complications (OR 0.85, 95% CI 0.55 to 1.30, p=0.44) was observed for partial nephrectomy. Our findings suggest that patients undergoing radical nephrectomy have improved outcomes when treated by HV hospitals. Evidence of this in partial nephrectomy and nephrectomy with venous thrombectomy is however not yet clear and could be secondary to the low number of studies included and the small patient number in our analyses. Further investigation is warranted to establish the full potential of nephrectomy centralisation particularly as existing evidence is of low quality with significant heterogeneity.

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Mendeley readers

The data shown below were compiled from readership statistics for 13 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 13 100%

Demographic breakdown

Readers by professional status Count As %
Unspecified 2 15%
Professor 2 15%
Professor > Associate Professor 2 15%
Student > Doctoral Student 2 15%
Student > Postgraduate 1 8%
Other 4 31%
Readers by discipline Count As %
Medicine and Dentistry 6 46%
Unspecified 4 31%
Immunology and Microbiology 1 8%
Materials Science 1 8%
Engineering 1 8%
Other 0 0%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 09 September 2017.
All research outputs
#10,939,060
of 12,342,998 outputs
Outputs from BMJ Open
#8,983
of 9,589 outputs
Outputs of similar age
#227,338
of 269,387 outputs
Outputs of similar age from BMJ Open
#567
of 618 outputs
Altmetric has tracked 12,342,998 research outputs across all sources so far. This one is in the 1st percentile – i.e., 1% of other outputs scored the same or lower than it.
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