Do Physician and Hospital Characteristics Influence Use of Radical Cystectomy in Patients with Bladder Cancer?

Research indicates that just one of five patients with muscle-invasive bladder cancer receive radical cystectomy, despite being recommended by the American Urological Association. Researchers assessed whether differences among diagnosing physicians and hospitals impacted the decision to proceed with radical cystectomy. However, they found that physician and hospital factors do not largely contribute to the receipt of radical cystectomy. The results of the study were presented at the 2019 ASCO Annual Meeting.

This cohort study used linked Surveillance, Epidemiology, and End Results-Medicare database information from 2002 to 2011. Researchers included older adults (>65 years) who were diagnosed with muscle-invasive bladder cancer. The urologist who performed transurethral resection of the bladder tumor was assigned as the diagnosing physician for each patient. The diagnosing physician was assigned to a hospital where he or she performed more than half of all urologic surgeries.

Researchers constructed a two-level hierarchical model in which patients were nested within hospitals to determine the association of patient, physician, and hospital characteristics with radical cystectomy use. A total of 7,097 patients were diagnosed by 4,601 physicians who were affiliated with 822 hospitals. The overall radical cystectomy utilization rate was 26.5%.

Less than 5% (4.8%) of the variation in radical cystectomy was attributed to the hospital level. In the model, patients diagnosed by female physicians were more likely to undergo radical cystectomy (32.8% vs. 25.8%; odds ratio = 1.63; 95% confidence interval, 1.31-2.02).

Higher radical cystectomy volume by diagnosing physicians and hospitals increased the radical cystectomy use (see TABLE).

Age, years in practice, and employment status of the diagnosing physician, as well as facility characteristics such as teaching states, location, and type of hospital, were not associated with radical cystectomy use. Some patient characteristics, including age, male sex, and higher comorbidity burden, were associated with a lower likelihood of radical cystectomy use.


Mehta HB, Golla V, Ray-Zack MD, et al. Association of diagnosing physician and hospital characteristics with the use of radical cystectomy among patients with muscle-invasive bladder cancer. Abstract #6576. Presented at the 2019 ASCO Annual Meeting, Chicago, IL, June 1, 2019.

Association of Physician and Hospital Volume With Radical Cystectomy Use
CharacteristicsRadical Cystectomy UseOdds Ratio
Diagnosing physician radical cystectomy volume (reference = 0)18.3

(95% CI, 2.39-3.17)


(95% CI, 1.85-3.40)


(95% CI, 1.84-3.16)

Hospital volume of radical cystectomy (reference = 0)20.6

(95% CI, 0.90-1.45)


(95% CI, 0.86-1.56)


(95% CI, 1.13-2.32)

CI = confidence interval