Source of Funding: None

1629IMPACT OF SURGICAL VOLUME ON PERIOPERATIVEOUTCOMES AND COSTS OF RADICAL CYSTECTOMY:ANALYSIS OF THE MARYLAND HEALTH SERVICES COSTREVIEW COMMISSION DATABASE

Michael Gorin*, Max Kates, Jeffrey Mullins, Phillip Pierorazio,Deborah Kaye, Brian Matlaga, Mark Schoenberg, Trinity Bivalacqua,Baltimore, MD

INTRODUCTION AND OBJECTIVES: There is growing evi-dence that increased surgical volume is associated with improvedhealth outcomes and cost savings. The objective of this study was toevaluate the impact of hospital case volume on perioperative outcomesand costs of radical cystectomy (RC).

METHODS: The Maryland Health Services Cost Review Com-mission database was queried for patients who underwent an open RCbetween 2000 and 2011. The study cohort was then divided into threeapproximately equal groups (i.e. tertiles) based on hospital case vol-ume. Groups were compared for differences in length intensive careunit (ICU) stay, length of total hospital stay, rate of in�hospitaldeaths, and inflation�adjusted medical costs. Further, multivariatelinear and logistic regression analyses of outcomes were performedadjusting for year of surgery, age, sex, race and medical complexity/mortality risk.

RESULTS: In total, 1620 patients underwent a RC in the stateof Maryland during the study period. Of these patients, 457 (28.2%)underwent surgery at 37 low-volume centers, 465 (28.7%) at 6 mid-volume centers and 698 (43.1%) at a single high�volume center. Themean yearly case volume of each group was 1.0 � 1.0, 6.5 � 2.7, and58.2 cases/year, respectively (p � 0.001). On univariate analysis,increasing procedure volume was associated with reductions in lengthof ICU stay (1.3 � 3.6, 2.4 � 5.7, 0.7 � 1.5 days, p � 0.001), length oftotal hospital stay (12.1 � 9.8, 11.1 � 10.0, 9.5 � 6.0 days, p � 0.001),rate of in-hospital mortality (5.9%, 1.7%, 0.3%, p � 0.001) and totalinflation-adjusted medical costs in thousands of U.S. dollars (39.2 �34.5, 42.0 � 38.6, 30.8 � 19.1, p � 0.001). On multivariate analysis,having surgery at the single high�volume center was independentlyassociated with a decrease in length of ICU stay (coefficient � �0.42[95% CI �0.79-�0.06], p � 0.023), total medical costs (coefficient ��$2.91k [95% CI �4.15-�1.67], p � 0.001), and in-hospital mortality(OR 0.19 [95% CI 0.04�0.81], p � 0.025). Decreased total costs weredriven by reductions in charges associated with the operating room,drugs, radiology tests, supplies and physical/occupational therapy (allp � 0.001).

CONCLUSIONS: Patients undergoing RC at high-volume med-ical center have shorter ICU stays and a reduced risk of death in theperioperative period. This translates to decreased costs associatedwith this procedure. In light of these data, we believe that patients inneed of a RC should be referred to a high�volume center.

Source of Funding: None

1630PROSTATE PATHOLOGY IN PARTIAL VERSUS COMPLETESUBMISSIONS OF CYSTOPROSTATECTOMY SPECIMENS

Zhan Tao (Peter) Wang*, Emily Filter, Manal Gabril, Jose Gomez,Johnathan Izawa, Joseph Chin, Madeleine Moussa, London, Canada

INTRODUCTION AND OBJECTIVES: The incidence of clin-ically significant prostate cancer (PCa) in cystoprostatectomy (CP)specimens is 25%. There are no guidelines for the pathologicalexamination of prostates in CP specimens. In our institution, prior to2000, the prostates were partially submitted whereas currently allprostates are completely submitted. The aim of this study is toevaluate the incidence, pathological features and clinical outcomesof patients with PCa found on CP specimens with partial versuscomplete submission.

METHODS: CP specimens with incidental PCa were identi-fied from our archives between 1990 to 2006. Patients with knownmetastatic PCa, previous radiotherapy or partial prostatectomy wereexcluded. A total of 72 patients were found, 51 (complete group) hadCP specimens that underwent complete submission versus 21 (par-tial group) that were partially submitted. Clinical outcomes wereretrospectively collected via paper and electronic charts. Each CPspecimen was retrieved and reviewed by the pathology department.Clinically significant PCa was defined as: Gleason score � 7,seminal vesical invasion, extraprostatic extension (EPE) and posi-tive surgical margins. Statistical analysis was performed with theStudent t-test, Fisher’s exact test and the Kaplan-Meier method.Significance was set at �0.05.

RESULTS: Patient demographics between the two groupswere similar. Median follow-up for the partial and complete groupwere 65.7 and 72.9 months respectively. There was a total of 40(55.5%) clinically significant PCa, of these 13 were in the partialgroup versus 27 in the complete group. Positive surgical margins atthe apex was found in 7% of specimens and EPE was found in 2versus 11 specimens in the partial and complete group respectively.Invasive urothelial carcinoma was found in 7 specimens in the partialgroup versus 11 in the complete group. There was one death frommetastatic PCa in the complete group and none in the partial group.There was no significant difference in overall mortality between thetwo groups (Figure 1).

CONCLUSIONS: This study comparing partial versus com-plete submission of the prostates in CP specimens showed nosignificant differences in the detection of clinically significant PCa orsurvival.

Source of Funding: None

e670 THE JOURNAL OF UROLOGY� Vol. 189, No. 4S, Supplement, Tuesday, May 7, 2013